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The following articles cover issues important to parents of children with special behavioral and learning needs. Hopefully, these articles offer an unbiased point of view that helps you evaluate what you might need or want to know in order to help your child. The cover issues regarding behavior and parenting techniques, and finding the right kind of school or home program for your child.

David Sponder, L.E.P., BCBA, Floortime C3c
Executive Director, Sponderworks Children’s Services

Behavior

Why Does My Child Act This Way – How Loving and Capable Parents can have Children with Behaviors Resembling Autism or Attachment Dysfunction

Encouraging Thinking and Cooperation, Reducing Oppositional Behavior

Parenting Techniques

Checklist for Guides using “Child-Lead” teaching techniques

Guided Participation: A brief definition and what it means to be a “Guide”

The Therapeutic Pause Technique for Teaching New Skills and Responsible Behavior

Prompting – Pros, Cons, and Otherwise

Language Techniques Used at Sponderworks: Techniques for Atypical Language Learners and Children with Autism and other Disorders of Relating and Communicating

Declarative Language Stimulation, a powerful technique for getting more communication, sharing, and cooperation

Teaching Logical Thinking by Challenging: Tools from Systems Theory: “Violating Expectations” and the “Therapeutic Pause”

Techniques for Increasing Nonverbal Intelligence, Thinking, Initiation and Cooperation while Reducing Prompt Dependence at the same time

Dealing with Behavioral Challenges

The Therapeutic Pause Technique for Teaching Cooperative Behavior and Independent Thinking

Dealing with Attention Seeking and Sibling Rivalry in a Relationship-based Way

Dealing with Explosive Behavior

 

Finding a Program that is Right for Your Child

Characteristics of a Home Program Focused on Quality of Life

Characteristics of a School Program Focused on Quality of Life

Map of a Consultation Model: View from a Parent and a Professional

Brazelton and Greenspan’s Irreducible Needs of Children

The Autism Wars, “Evidence Basis” and ABA as both an Open System and a Bottom Line for Judgment of Effectiveness

An ABA Analysis of Floortime and Guided Participation Teaching

What is Developmental Observation?

Developmental observation is required in this method. Developmental observation has several forms:

Simple Developmental Observation (Unstructured): This can and should be done over several days and across settings. The Analyst observes the child at play, socializing, and solving problems encountered in the IP’s natural environments. The Analysts looks at the means of exploring, discovery and problem solving the IP uses.Observations of toy and dramatic play can be particularly revealing in the case of younger children. People have a strong tendency to reveal who they are by what they find interesting or not, and howthey pursue what is interesting to them.A related process can be done with error analysis of an older individual’s academic work and performance on tasks.  From this data, the Analysts looks to the hierarchy to identify skill clusters that match other behavioral clusters found in the stage.Skills tend to cluster along a bandwidth or range of skills in most individuals. Developmental analysts look at where the majority of skills seems to be (the “Functional range”), and the upper (“Ceiling”) and lower (“Basal”) ends of the range.

• Basal Range: This is the range of skills already acquired and comfortably used by the IP. These skills are relatively solidly established, and are reliably used by the IP even when compromised (e.g., tired, hungry, irritated, etc.).  These skills also tend to be used in novel or challenging situations.
• Functional Range: This is also a range of skills already acquired and fully in use by the IP, but that may not be evident under special conditions of compromise, novelty or challenge. The skills are generalized for the most part and therefore useful in most settings and most situations for the IP.
• Ceiling Range: This refers to the ZPD. The IP may possess scattered or weakly developed skills in this range, or may only be able to do them under certain conditions or with support. Skills are unreliably produced in this range.

Structured Developmental Assessment: The Examiner exposes the person to toys and objects that children tend to play with at different stages of development. Typically, the Examiner has toys available in a play room or assessment environment for the IP to select (for older children, other objects can be used). As mentioned, the selection of objects/toys can reveal important clues about the IP’s development, as well what they do with the objects when they interact with them.

Developmental Inventories/Checklists/Profiles: These are lists of behaviors typically seen at the various stages of the hierarchy. This is best done face-to-face with an informant, using a criterion-referenced assessment tool. Informants are people that by virtue of their familiarity with the IP, can answer items on the developmental questionnaire. Typically, those are the Parent(s), Teacher(s) and often, the IP.  The most popular and well-regarded Developmental Inventories/Checklists have separate forms for Parents, Teachers and Child (IP).It is not a good idea to simply hand a Parent (or especially a child) a developmental inventory/checklist and just ask them to fill it out. That is because there can be (and usually is) room for different understandings of items on the test.  Since these are criterion referenced measures, the IP cannot fail it, and the score derived from the test should never be used for making any sort of decision. Used properly, a developmental checklist or inventory should not resemble a test. It is merely a tool to guide observation and to organize the data.

Caution regarding assumptions made from the data: The Analyst has to be an intelligent consumer of developmental checklists. He or she has to look at the items on the checklist to determine whether the tool has a bias towards skills that are normally taught using behavioral teaching methods. For instance, the IP may be able to tie her shoes, but the rest of her development does not match this level of skill. That might be because the skill might have been taught using behavioral shaping and chaining procedures that produce reliable but rote performance of specific adaptive skills. We want to be sure that we are measuring developmental processes, not just acquired skills.

Extreme caution regarding the reporting of Developmental Age(s): Many commercially available developmental checklists yield a “Developmental Age” from the data. Items are weighted by scores for each item that denote the level of skill achievement is concerned. For instance, an inventory item such as “names at least one color correctly” might be answered with a 0 for “never” or “not at all;” a 1 for “sometimes;” or a 2for “always.”  A total of the scores are added up and compared to scores obtained from a normative sample. The “developmental age score” equates the IP’s raw score (number of items correct or sum of the item scores) is the same as the average raw score for the normative sample of a specific age or grade. Age equivalents are written with a hyphen between years and months (e.g., 9–4 means that the age equivalent is 9 years, 4 months old). A decimal point is used between the grade and month in grade equivalents (e.g., 3.2 is the third grade, second month).Developmental age scores do not reflect developmental stages. They try to do what standard scores do – provide a score that is useful for comparison among individuals. But standard scores do this by converting data into equal intervals. So the difference between a score of 102 and a score of 105 is the same difference as any other two scores that are 3 points apart.Now consider the qualitative differences between development at 11 months and 30 months – a difference of 19 months of development. Typically developing children are vastly different people at these two ages.  Now consider the difference between two individuals where one of them is 56-4 (56 years and 4 months old) and a person who is 57-11 (a difference of 19 months) means what? These scores point out that “months of development” are not equal. It gets even worse when the tool asks you to add up and/or average the scores of different domains of development to yield a so-called age of ‘Overall Development.’ An even more egregious is the practice of taking the derived developmental age scores from various domains of development and adding them or averaging them.

Developmental Observation Tools: This involves the administration of test tasks or the presentation of specific materials to evaluate the IP’s interaction with them.  The Examiner presents specific “stimuli” to the IP and records the types of responses given by the IP.  For instance, the Examiner might present a simple 3-piece formboard puzzle (insets: circle, triangle, square) to the IP.  If the IP does not use it at all or uses it inappropriately (e.g., puts the puzzle pieces in her mouth), a score of ‘0’ might be given.  If she performs the task using random trial and error, a score of ‘1’ might be given, and if the IP places the pieces in the formboard by looking at the pieces and the inset shapes and then puts each piece in with accuracy and certainty, then a score of ‘2’ might be given.

Developmental assessment should always involve the use of unstructured developmental assessment across a time interval (less than a month) and across settings (home, school, community, peers).

The Cognitive Skills Sections

This section is long and involved.  I recommend that you read it in full, and then, when preparing your report, pick among the features or aspects of cognitive behavior described below that you think contribute in some manner to the behavior.  In other words, indicate only significant features that best help you describe the discrepancy between cognitive behaviors demanded by the environment and those possessed by the client.

• You DON’T want to list every deficiency you can find.  List only those that possibly could have a functional relationship to (influence on) the behavior.Deficient skill sets that you do identify must be deficient for the circumstances – resulting in an increased likelihood of the behavior under certain demand conditions.
• You DO want to include the cognitive skill sets that are required wherever the behavior is observed and in what way.  In other words, you must describe the demands of the environment in terms of the mental skills that are required for the IP to adapt.
  • If you suspect the IP lacks a needed skill, you must identify what it is and how and why it may contribute to the behavior.  It is best to try things to test your hypotheses.  You can provide assistance or modifying tasks or doing some initial teaching or more appropriate forms of behavior for instance.
  • The particular skill(s) lacking in the IP (but still needed in the environment or by the task or social demands) become the most logical ‘skill targets’ for teaching more appropriate replacement skills.In plain words, you try to teach the IP what he or she needs to know to be a better Citizen of the environment.
    • Applied Behavior Analysis assumes that for any problem behavior under assessment, there is a more appropriate skill or skill set (called a response class) that can replace it.  If the “replacement behavior” is well-chosen, it will replace the need for inappropriate behavior.The new, replacement behavior (skills) will probably serve the same function as the problem behaviors did.  The new behaviors simply represent more appropriate forms of behavior.
• We use taxonomies as heuristics for looking for replacement behaviors from the IP’s Zone of Proximal Development.  This avoids a haphazard or poorly sequenced towards teaching targets or behavioral steps to learn.

Assessing Cognition

This chapter of the manual describes various features of mental behavior (commonly referred to as cognitive processing skills), that are observable through overt actions.

Mental behaviors are “private events” as Skinner put it, but the evidence of them can be quite obvious in patterns of behavior and responses to teaching and consequences in the environment. In Applied Behavior Analysis, you can only describe what you can observe.  As always, you begin by observing behavior in the environments in which it occurs. In developmental psychopathology, you know that certain behaviors are highly correlated with certain mental processing pre-requisites.  You can see the evidence of their lack in the IP’s behavioral adaptation to the environment.

You also know that simply because behaviors are correlated to certain forms of processing in the scientific literature, or by your clinical judgment, or even by tradition – there is no assumption that there is a cause and effect relationship. On the other hand, the processing profile of the IP may have little to do with the behavior.  There is a strong possibility that behavioral observations in the environment alone will not show sufficient evidence of any relationship between a known processing deficit in the IP and the behavior.

If you suspect that the behavior is somehow related to a cognitive skill that is needed in the environment or by the demand, than you would look for any evidence of the IP’s using that skill in that context, or, in others.  The degree in which the IP lacks that skill is likely correlated somehow with its occurrence.  But you don’t know that until you assess the skill.

A good place to start is to look for differences in the skills used in different environments and contexts. If you do not see any evidence of the IP using or possessing the needed skill, or you see that the behavior is somehow a result of mistaken learning, you can further test that skill set by some sort of manipulation of the environment.

• You can test your assumptions by providing some sort of challenge or assistance

Test Data

A form of the above is test data.  These are very special manipulations of the environment designed to provide both quantitative and qualitative evidence of a processing skill.

This is why I strongly recommend a serious review of available test data.  Test data provides:

• Profiles of cognitive strengths and needs
• The quantity and quality of mental processing skills the IP possesses
• The possibility that mental processing errors, evident from test data, are correlated to observable behaviors in natural environments or under specific or general demand conditions

Specialists qualified to give formal tests and reports on mental processing should provide the interpretation of test data and the subsequent correlations to behaviors observed in the environment.  This correlative or predictive information may not be provided in their reports.   Much of the time, specialists do not provide the specific correlation that you’re looking for or, or any real useful information other than raw data.  If they are available to you – I strongly suggest interviewing that particular examiner.

Typically, Specialists provide information about processing in their particular domain of specialty.  As far as cognitive information is concerned, specialists such as Psychologists, Special Education Teachers, and Educational Therapists often give tests that provide evidence of cognitive processing.  Their reports give the results and data from testing, and hopefully – a useful summative interpretation of the data that you can use to refine your hypotheses about the ‘functions of’ and ‘functions for’ behavior.

It is wise for every analyst to develop a working knowledge however.  That is what this chapter should help you do.

Cognitive “Processing”

• Cognitive Processing is what happens between the consequence of one’s behaviors and the antecedent “setting conditions” for the next occurrence of behavior.
• Behaviors under assessment always reflect some sort of discrepancy between what the environment, context, social interaction or task demands, etc., expect, and the skills the IP possesses for adapting to them.  If the IP lacks skills to meet environmental demands, then there is the potential for that lack of skills to function as an antecedent setting condition for the behavior.
• In this method of functional analysis, mental processing and developmental foundations matter.  A person’s responses to consequences in the environment have everything to do with how he or she perceives them.  Information processing tests, developmental observation inventories, error analysis and other tools for understanding how the individual perceives what goes on in the world provide a valuable and necessary contribution to our baseline logic.
• The Applied Behavior Analytic method calls for us to find the function of the behavior under assessment.  The behavior is almost always “under assessment” because its formis inappropriate – not its function.  In other words, the function of the behavior is valid (e.g., wanting attention; wanting a change in demand…), but something about its form is problematic:
  • Its topography is inappropriate (the way it is expressed or acted out)
  • Its timing is inappropriate (e.g., wants attention, but cannot wait or wants it at the wrong times)
  • It is inappropriate because of the amount of it (e.g., too much; too long; too frequently; also: too little; not long enough; not frequent enough; too soon or too late, etc.)
  • It is inappropriate because of the amount of it (e.g., too much; too long; too frequently; also: too little; not long enough; not frequent enough; too soon or too late, etc.)
  • The intensity is inappropriate (too loud/soft; too hard/soft, etc.)

Once the function of the inappropriate behavior is identified through the process of functional assessment, intervention then involves teaching appropriate “replacement skills” that serve to meet the same function (e.g., the person learns to wait or raise his or her hand to get attention).  It is at this point that developmental assessment – the assessment of the person’s prerequisite abilities to learn or comprehend the new skill – where any sort of developmental assessment is necessary.  Without a good knowledge of the tools the IP has and the cognitive pre-requisite skills he or she possesses, choosing replacement skills can be a haphazard process.  Too often, the skills chosen are so outside the IP’s developmental capacity that he or she will never progress beyond the most rote levels of competence.

• In this section on Cognitive Assessment, we look at three main areas of cognitive/adaptive behavior function:
  • The basic foundations for learning and developing (Motor Planning and Sequencing and the ability to Organize Thoughts and Actions);
  • The Means and Tools the IP possesses for learning; and
  • The IP’s capacities for abstract thought
  • We use well established and research supported taxonomies of typical development as reference points for assessment of environmental or task demands as well as the skills the individual possesses.  From these two points we can see if there is a discrepancy and we at least consider this discrepancy in our baseline logic.

Greenspan and Greenspan: Motor Planning and Organizing Thoughts
Vygotsky: Means of Developing Cognitive Tools
Piaget: Means of Developing Abstract Thought

Why Use Taxonomies

All aspects of biological development in the plant and animal kingdoms manifest typical stages of development.  These stages are individual, qualitatively different systems of behavior.  The IP’s behaviors interrelate with one another to form a whole that can be defined by a common feature, function or topography.  Emergent behaviors are not mere extensions or elaborations of earlier skills.  They do not follow a smooth line of progression upwards. Typical development, consistent with systems phenomena and systems theory, is marked by quantum leaps and the sudden emergence of new forms and functions (i.e. a new stage).

According to the principles of developmental psychopathology, we use typical development as a reference point for understanding atypical development.  Typical development is organized into taxonomies by the biologists and the child development researchers that devise them.

• In the Behavior Assessment Report, it is not important or even wise to report the stage or level of any taxonomy in which we think the person functions.  This can lead to wrong assumptions of the IP’s actual potential, and imply that behaviors come from the stage itself.

Instead, we take an “ecological approach to perception.”  This provides us with a theoretical basis for assumptions we might make about the relationship between covert mental events (representations; percepts; concepts; motor plans) and overt behaviors. This view suggests that “…the way to understand human cognition is to study the moving, acting human as he or she exists (and evolved) in real-world contexts.” (Johnson & Soska, 2008)

• No behavior comes froma stage or level. Consistent with Applied Behavioral Analysis, behaviors are still under the control of consequences. Behaviors tend to have similar forms due to a confluence of many factors, many dependent on the growth of physical strength, size, and neurological maturation (genetic factors), as well as exposure to cultural expectations and consequence in the environment.What happens is that there is a confluence of factors that combine to cause a shift.  In mental development and behavior, there is usually a predominant type of behavior (sometimes called a “leading part, ” “dynamic attractor” or “trigger;” e.g., 9-month-old babies tend to reach and grab and put things in their mouths: this is one of the leading activities of this Piaget’s Sensorimotor Substage IV).  A small change in this predominant, leading activity of the stage can have amplified effects on the system as a whole because the reaching and grabbing behaviors dominate the stage. The emergence of new neural structures and manual dexterity coming on line may permit a different appreciation of reaching… the maturation of visual/spatial skills may now make reaching and looking more satisfying and the ability to manipulate the object with one’s fingers may make such manipulations more reinforcing than simply grabbing.  The child’s history of mouthing objects may mean that he or she is no longer as reinforced by mouthing as he or she is now by looking.

Behavior Analysts need to have access to more developmental information and to use it more wisely than they currently do.  They need to understand that while stages don’t cause behaviors – behavior still functions according to systems principles. The remarkable similarity of leading behaviors among individuals at certain ages implies strongly that we inherited a certain “phylogenetic” bias towards reinforcement at various stages of neurological maturation.  We believe that it is unwise to ignore or to be ignorant of the qualitative nature of the behavior and its similarity to behaviors typical of a neurotypical stage.

Taxonomies and Stages or Levels

A stage or level is simply a description of a response class of behaviors that have a similar feature or function. Behaviors under assessment can represent atypicality and typicality of development at the same time.  A very common presentation for behavior assessment is behavior that may “be typical” of (represent typicality at) an earlier age, and atypicality or even problem behavior, at the IP’s chronological age.

The environment will have a set of expectations for appropriate behavior for individuals that are the same chronological age as the IP.  But the IP does not have the developmental skills to adapt like others his or her age.  This is the discrepancy between environmental expectations and IP’s skills that we always talk about.  The analyst must then choose behaviors that are more appropriate and adapted in which to teach the IP.

• Taxonomies can useful for predicting likely sets of responses to given antecedents and setting conditions. This predictive value can apply:
• If intervention seeks to simply suppress current forms of behavior – the function remains the same and the IP has not been taught a behavior to meet that function that is more appropriate (FERB). Therefore, if the old, inappropriate behavior is merely suppressed, what you can expect is that the behavior will merely change form – not function.  The new forms will more than likely share features of others in the particular level or stage of the hierarchy, or, from a lower stage. They will more than likely be variations on the old, inappropriate form and inappropriate as well.
• Because of this phenomenon, if the replacement behavior targeted for teaching is similar in form and function to the old one, than it is likely going to be more easily learned by the IP and easier to teach.  The analyst can look to other behaviors found in typical development at the stage in which the IP functions as replacements.  These are much more likely to work than forms of behavior that come from stages that are too high up on the hierarchy.
  • The child’s Zone of Proximal Development (the next stage up in a given taxonomical hierarchy) – as seen in typical development – provides the universe of choices for selecting replacement behavior to teach. The information is useful for determining which replacement skills are possible and at what level of complexity the individual is likely to profit from instruction.

Cross Analysis

The taxonomies we use to guide our assessment of cognitive development are all derived from observations of behavioral forms seen across the course of cognitive development in typical individuals.

What we mean by “cross analysis” here is that we can look at the behavior under assessment to determine whether it belongs to larger “functional response class” or repertoire of behaviors that shares the same rules as those of a particular stage or level [in the hierarchy of] a taxonomy of typical development.  In other words, we want to know whether behavior under assessment is characteristic of a known stage of typical development.

As we pointed out earlier, suppression of the behavior will result in a behavior of similar topography or with similar features and functions taking its place, and that new form will not likely be a more appropriate one without proper teaching.  And, when the Analyst chooses new behaviors to teach that are supposed to replace the old ones, picking behaviors that are also within that stage or the next stage up (ZPD) will more likely result in success.

Motor Planning and Sequencing

For a more detailed account on Motor Planning… Read more

Stanley Greenspan’s Taxonomy of Motor Planning and Sequencing

“…we must perceive in order to move, but we must also move in order to perceive.”
Gibson, J.J. 1979. The Ecological Approach to Visual Perception.  Boston: Houghton-Mifflin

Motor planning is what the brain does along with the body to coordinate perception, attention, thought, memory and action.  The brain takes in information through the senses, processes the information; and then “plans” and “sequences” preliminary responses to the environment; and then, the brain sends signals to the muscles execute the actions – in sequence.  Once the actions begin, they cause changes to the physical and internal environment that must be processed by the brain and perceived so that actions can adapt to the changing conditions.  Piaget had a similar concept that he called the “perception-action” cycle.

“Neither perception nor action alone is sufficient to … perform goal-directed actions. Moreover, each time the same action is performed (e.g., reaching for a glass), the initial conditions between the actor and the goal (e.g., distance and size of the glass, posture, inertia of the limbs) will differ requiring variations in the movements and the response.

In view of these many factors that must simultaneously contribute to the execution of a goal-directed action, it would be misleading to conceptualize perception and action as independent processes. Instead, it is much more parsimonious to view these processes as opposite poles of a functional unit or action system. The earliest developing action systems will be those related to supporting biologically adaptive functions, such as orientation, exploration, locomotion, manipulation, and communication. All spatially and temporally coordinated behaviors require the coupling of perception and action. For example, reaching for an object is guided by perceptual information specifying the relation between the self and the environment which changes as the reach progresses. These perceptual changes produce adjustments to hand and arm movements to insure that a reach is successful, which, in turn, modify the perceived relation between the reach and the target. Similarly, perceptual information is necessary to maintain a balanced posture during the reach, but again the perceptual information changes as the posture is adjusted to that information.

Perception and Action, paper by Bennett I. Bertenthal; Chapter to appear in M. Haith & J. Benson (Eds.). Encyclopedia of Infant and Early Childhood Development. Elsevier.

According to the Greenspans,

“Every aspect of play and learning involves planning and sequencing. In all our projects, we first have to form an action plan in our heads – a number of steps done in a certain order to achieve a desired result. With elementary school children, we can see these action plans conveyed in their pretend play – the plot behind cowboys and Indians at recess of the fresh wrinkles in the backyard adventure story they keep the action going. As children get older, planning and sequencing guide their studies – preparing for the test, juggling multiple homework assignments, or organizing and writing a long paper. But although planning problems related to movement are fairly obvious because the results can be seen, these at the higher levels of thinking are not as obvious because they are somewhat hidden. They frequently get misdiagnosed and mislabeled.” (Greenspan, 2010)

The most important aspect of motor planning is that perceptual and motor processes happen either simultaneously or in rapid serial exchanges of energy across the brain.  For optimal performance, there has to be “coherence” among multitudes of constituent neurological circuits.  In response to changes in the environment, the brain “recruits” ad hoc neural processing assemblies to enable thought and action to work together in real time.  These circuits must cohere, meaning that they must be able to work smoothly and in synchrony.

Glitches: processing anomalies existing anywhere within the [currently active] network of neural processors, such as a processor functioning too slowly or too quickly or in a distorted way, can serve to “bottleneck” the flow of energy and result in breakdowns of motor planning and sequencing.  This bottleneck or glitch can be seen in a variety of ways in behavior: from basic clumsiness and obvious difficulties planning movements, to [at the higher levels] difficulties managing thoughts (executive function).

We maintain that a primary feature of pervasive developmental disorders from mild (e.g., ADHD/ADD or Specific Learning, Communication, or Motor disorders) to severe (Autism Spectrum; Cerebral Palsy; Thought Disorders), is the difficulties the brain has managing input processes (i.e. sensory uptake; monitoring ongoing sensory information) and output or production processes (i.e. forming perceptual and conceptual representations; organizing thoughts and organizing action sequences, creating anticipations from information stored in various forms of memory, etc.) simultaneously.

Stanley and Nancy Thorndike Greenspan’s taxonomy of Motor Planning and Sequencing corresponds to Stanley Greenspan’s Nine Functional Emotional Milestones, which were developed through direct observations and tests of typical child, adolescent and adult development conducted by many researchers. In “The Learning Tree,” the Greenspans use the analogy of a tree, where the roots of the tree function as the basic uptake or perceptual systems and where the trunk organizes the basic integration of perception and movement of the body system, the branching (elaboration and full fruition of the system) represented by executive processes requires a well-functioning root and trunk system.  Consistent with the metaphor of a tree, it is the roots that develop first – basic abilities to process sensations, form percepts and to coordinate simple actions.

Imagine the roots branching out into the soil (a metaphor for the environment).  The tiny branches and capillaries emanating from the root stem are a metaphor for individual neural processing assemblies and aggregates of smaller assemblies (megasystems).  For instance, one of the root stems would represent [metaphorically] the vision system – visual perception.  One of this root’s capillary systems might process the shape of an object, another – the color, another – its position and another – its movement through space.  This information gets fed into the root stem, where it is aggregated into a single, unified and coherent visual perception of the object.  The aggregated information at that first level of processing (called “perception binding”) feeds into the trunk system, which at the same time receives information from other major root stems: one for every sensory system; root and capillary stems that monitor what is going on inside the body and others that collect information from the feedback the body gets from its own movements and actions, etc.

Just like any plant, the integrity of what grows further will be determined by the health of previous growth.  The trunk forms the foundations for all manner of complex thought and movement.  The trunk is where sensory and motor information from the roots combines and integrates.  Unlike the root system, the trunk is above the soil and we can see it.  The trunk does not move as freely as the limbs, branches and leaves of the tree, so that could be a metaphor for sensorimotor behaviors – simple actions based mainly on percepts rather than concepts.  Here, we look at the roots and the trunk to see whether problems at higher levels (the limbs, branches and leaves of elaborated and abstract thought) are due to incomplete mastery of earlier levels of the taxonomy.

Thinking of the roots of behavior in this way has strong implications for neurodevelopmental intervention, where work is done to strengthen the systems from the bottom up.  Developmental therapies work in this way.  Behavioristic treatments on the other hand, focus mainly on what is above the surface – the observable.  But this top-down approach can amount to trimming a sick tree.  It may look better, but we can’t be sure if it’ll grow further or really be able to branch out on its own.

Continuing with this metaphor, environmental intervention could be like working with the condition of the soil, the amount of sunlight and water and nutrients, etc.  We usually recommend a combination of bottom up and top down approaches, as we can see from this metaphor that both can be of benefit.

Growing Up

The outline of the Greenspan’s taxonomy of Motor Planning and Sequencing abilities starts with behaviors observed in typical development at fetal and neonatal ages and progresses through the life-span of typical development.  In typical development, the hierarchy progresses from simple forms and grows in complexity, differentiation and integration (consistent with general systems theory).  Also consistent with developmental and biological systems, progression is marked by qualitative leaps rather than in smooth linear progression.  But in general, development of motor planning and sequencing begins with mastering basic sensory and motor response processes and moving from reflexive responding to intentional behaviors of increasing complexity.

At the earlier stages, the focus of adaptive processes is on the body.  Beginning in the second year, children go beyond forming intentions and acting on them, and beyond simple experience-sharing and problem-solving.

After the infant/toddler period, the processes of motor planning and sequencing can occur executively or within the mind and usually precede overt action.  Before that, intentions and actions were pretty much entwined. Therefore, higher up in the taxonomy, the focus is on the ability to represent the environment mentally with symbols of actions rather than the actions themselves.  Memories can be represented in a way that can be used for guiding future actions as never before.  Language develops as an internal symbol system for thinking, and later on – symbols of symbols such as pictures, objects, words and written forms of language enable ever-increasing complexity in motor planning.  This is the advent of “executive function,” which begins mid- to late in the second year of typical development.

At the level of “executive function,” a good deal of processing occurs internally before overt behavior can be observed.   At these levels of planning and sequencing higher up in the hierarchy the focus is on “…the planning and sequencing of ideas that direct the movement [italics mine] rather than the movement itself” (Greenspan S. a., 2010).

At the executive systems level, children begin to work with multiple thoughts.  They can mentalize (represent and act on internally in the mind) ideas and the actions involved, imagine the consequences and effects, anticipate the consequences and pre-plan problem-solving, evaluate their own actions and motivations and those of others, etc.  The mind can function well in advance or absent of any overt physical action.  The body does not have to do what the mind thinks, so inhibition and deferring action is now possible.  Importantly, one can imagine something and then, with new information and thinking, re-imagine.  They can think about a sequence of actions they might take, and re-sequence them if need be.

Stanley Greenspan refers to executive processing systems as the “Orchestra Conductor,” (Greenspan & Benderly, 1998), which I prefer.  In this analogy, if each of the individual processors are like individual instruments of the orchestra – each capable of its own range, type, quality and intensity of product, the executive’s job is to get them to work together for the purposes of making complex decisions.   I would add that just like any other neurological process, executive functioning is carried out by ad hoc assemblies of neurons recruited for the purposes of accomplishing a goal or solving a problem.  So there is no single place where this “Orchestra Conductor” can be found – no seat of the soul or homunculus.

We also know that this “binding of perception and movement also occurs at different, more elemental stages of processing in the basal ganglia, cerebellum and thalamic/limbic regions of the brain (Koziol & Budding, 2010).  Koziol and Budding point out that the role of an executive system to make decisions and that this happens not only in the systems commonly referred to as “executive” but also and importantly at various levels beneath consciousness.

But the executive system cannot do its job properly if it has to work with poorly processed perceptual and movement information. So in this sense, executive function is at the top end of the hierarchy of the taxonomy of motor planning and sequencing.

Discrepancy between Environmental Demands for Motor Planning and Sequencing v. the IP’s Capacities

The behavior under assessment may in large part be a “function of” the individual’s current capacities for motor planning and sequencing.  This occurs when the environment or context demands certain motor planning and sequencing abilities for adaptive behavior, and the IP has not yet developed them.

This taxonomy allows us to identify overt, observable behaviors that implicate problems with covert processes.  Treatment plans that take into account the individual’s needs to develop specific types of motor planning and sequencing – or at least provide some compensatory strategies to deal with the deficits (e.g., a schedule, sequence board, checklist, etc.) are likely to work.

From our assessment of the IP’s unique patterns of developmental accomplishments and capabilities in this domain, we can look at:

1. the types of motor planning and sequencing required for “expected” or “well-adapted” behavior in the context or environment; and then
2. compare that to the capabilities the individual actually has.

According to our discrepancy model, when the IP lacks abilities for motor planning and sequencing required by the context or particular demand, we have potential setting conditions for the behavior under assessment.  We include this possibility in our baseline logic and then test our hypothesis by examining the data from observation.

Outline of the Greenspans’ Taxonomy of Motor Planning and Sequencing

The following is an outline adapted from the Greenspans’ Taxonomy of Motor Planning and Sequencing according to Dr. Stanley Greenspan’s final publication before his death, “The Learning Tree; Overcoming Learning Disabilities from the Ground Up” (Greenspan, 2010). I include the characteristic functions and forms of behavior that characterize the stage, observable behaviors that demonstrate the quality of the mastery of the stage, and behaviors or associated problems that can result when the stage is not optimally mastered.

As with all taxonomies of human development, the milestones of emotional development and motor planning and sequencing are hierarchical.  Optimal development occurs when more complex forms (behaviors and behavioral response classes or systems) can emerge by bootstrapping on top of sufficiently mastered earlier forms.

In the Greenspans’ hierarchy, you can see that the person’s capabilities for motor planning and sequencing progress from basic and foundational to complex and multi-elemental. But, as is common in developmental hierarchies, each stage has its own progression from simple to complex.  The limits of elaboration and complexity of the skills within the stage depend upon the individual’s abilities and the environmental support they receive.

For instance, at the beginning of life (fetal and neonatal periods), the “developmental task” or optimal accomplishment of the stage is to establish “rhythmicity” (below).  For infants, we observe behaviors that indicate coherent responses to sensations rather than simply spastic, internally driven movements.  The infant begins to respond coherently to the environment: by showing interest in sights and sounds, by responding to sensory input, by being responsive to caregiver efforts to stimulate and/or soothe, etc.  A lot of this has to do with relative maturation of the Autonomic Nervous System facilitated by the regulation efforts of caregivers.  A person can go on to acquire more complex forms of motor planning and sequencing with or without optimal mastery of this foundational stage.  But the inoptimal mastery of this earliest stage may be evident in other forms of behavior throughout the lifespan.

In other words, we may see the deficient mastery of early stages even while the individual is older and has mastered skills at higher stages.  For instance, we may have a case of a middle-school-aged child that can think abstractly, but experiences easily perturbed moods that take too long or don’t resolve normally and explosive behavioral reactions to stress.  These would be signs that the individual has not really mastered “rhythmicity,” and the failure of mastery is a very likely a setting condition for behaviors like tantrums, failure to cooperate or other behavioral symptoms of inflexibility.

Another good example of how this works can come from looking at Greenspan’s Stage of “Logical Thinking.”  Logical thinking helps us understand that the fact that it is raining explains why the person arriving at the door is wet.  And logical thinking is how Einstein arrived at his theory of relativity.  In other words – there are no ends to these stages – just more elaborations and refinements of skills and (as biological systems always go) – a progression towards ever greater levels of differentiation, integration and complexity.

The following are some examples of how we can observe the development of logical thought that come from years of administering developmental tests.  Here’s a question from the Southern California Ordinal Scales, as might be answered by individuals at various stages of logical thinking…

Examiner: “Where does the sun go at night?”

Associative Level (Pre-logical):  “It goes down…” or, “It goes down behind the houses.”
This is simply an observation of what happens.  There is no “why” or connection between what happens and what causes it.

Beginning Logic Level:  “It goes to sleep.”
There’s definitely a “why” in there, but it is based only on perceptual thinking and a theory based entirely on the person’s own perceptual experience.

Concrete Logical Level:  ”It circles the earth.  That is why it goes down on one side and comes up on the other.”
This is still perception-based logic, but it is not magical thinking.  It is based on tangible experience.  Keep in mind that the human race believed this until the 15^th century (by that time, human logical thinking already existed for at least 150,000 years).  In this way, logical thinking is based on available observations and available testing.  Logical thinking is what science is all about and in just about any complex subject area – one’s logic is always susceptible to testing and subsequent change.

Formal Operational Level:  “It doesn’t go anywhere.  It just appears as if it goes down.”
This type of thinking must involve the hypothetical, since we cannot manipulate the sun and the earth.  It must show understanding of how perception can be fooled by phenomena.  For most of us, this comes from education and model demonstrations of how this works.  It would not occur to us on our own.  But the advent of generalized formal operational thinking does occur based on more experience with this type of thinking.

We discuss levels of abstract thinking in more detail using Jean Piaget’s taxonomy below. The above example involving understanding of the earth’s orbiting of the sun is possible through the “scaffolding” of teaching and models.  The notion of how the earth’s orbit works comes as a “cultural tool” (Vygotsky, below) since our predecessors figured it out and passed it along to us.  The point is, that if the IP has the foundations for such thought, you would then be able to analyze whether or not he or she has the necessary logical thinking skills to adapt to a given environmental demand.

Logical Thinking and Amount

The baby doesn’t mind someone taking some of her raisins because she does not yet understand that taking raisins away means that there will be less for her.

When she gets a little older she recognizes simple visual concepts of less and more, and she knows that what you take – means less for her.  She protests.

Addition requires merely the ability to count, whereas subtraction and higher operations require notions of conservation of amount.  If she turns away and sees less raisins, she can count how many are left in order to figure out how many are missing.

Algebra requires understanding the concept of a variable, not fixed amount

ORGANIZING ACTIONS

The first stages of the development of motor planning and sequencing involve develop the abilities to represent and store perceptions and to form concepts and to develop the ability to execute stepwise means of responding, exploring, thinking and communicating.

Name of Stage: Attention and Engagement with the World: Establishment of Rhythmic Responding

Characteristics: In the beginning of life, typically in the fetal and neonatal periods, movement is characterized by reflexive responses that operate on neural-motor circuits pre-wired at birth.  Movements are largely random and have a spastic, reflex type quality and are not subject to the intentions of the infant.

Achievements by the End of the Stage: Maturation of the nervous system and input from the environment facilitate the progression from random movements to more rhythmic and synchronous “responding.”  By “rhythmic and synchronous,” movements aren’t intentional yet, but they are more coherent responses to the environment than spastic reflexes in response only to internal sensations or random neural discharges.  The term “rhythmicity” is most often used in describing infant temperament and usually refers to the development of regularity of the biological functions of wakefulness and sleep, hunger, satiety and elimination, etc. – the basic biological rhythms of life.  Here, “rhythmicity” has more to do with the direct correspondence between environmental events and behavioral responses in the baby.  Movements are not random or spastic, but responses to stimulation.

This period of development usually represents the infant’s immersion from the womb into the blooming and buzzing external world outside.  The infant must learn to experience sensations without becoming overloaded.  This means that the sensory receptors have to be capable of sensing and responding in some way to stimuli (e.g., light, sound, movement, as well as to feel internal sensations of comfort or distress, etc.).  In order to develop coherent responding, the infant’s nervous system has to both notice stimuli and be able to register them on a sensory level.  The sheer amount of stimuli available in the environment is potentially overwhelming, so the infant’s nervous system must develop filters and modulators that regulate the intensity of stimuli.

Behaviors Associated with Deficient Mastery of the Stage: Regulation and modulation of sensory input allows the infant to become interested and develop ever better ability to make meaning of environmental stimuli, rather than to become impinged or overloaded and turn away.  The following behaviors are signs that the IP has difficulty at this level of motor planning:

• The IP is largely unresponsive and incapable of coordinated responses to environmental stimuli.  This is rare past early infancy or the early years of development even for very severely involved individuals.  Complete unresponsiveness and spasticity in older individuals is rare and represents a very tenuous connection to external events.  Individuals that are still at this stage beyond early childhood usually remain non-ambulatory and totally dependent on custodial care.  They are rarely referred for behavior assessment, but sometimes, repetitive behaviors can become self-injurious.  These individuals may respond to classical condition to change or develop some very simple responses and regularity in their behavior;

Much more common are severe problems with the regulation and modulation of stimuli.  The IP may go on to develop a wide range of complex skills and even normal or above IQs, but they remain subject to wide fluctuations in their performance due to the perturbation they experience when encountering certain forms of stimuli.  Behaviors under assessment usually fall into the functional category of automatic positive or negative reinforcement seeking.

• Fails to register certain sensations at all.  Doesn’t notice events or changes that occur in the environment (see “Inattentional- or “Change Blindness.”  This leads to a failure to develop interest in the world and a subsequent deficit of means for exploring and learning from the world;
• Over-registers (under-modulates; under-filters) stimuli.  In early infancy, this can begin a series of cascading and eventually catastrophic effects on development.  Since the infant cannot move away from stimuli or block it out by or covering their ears or eyes, stress can reach levels where the infant’s brain simply shuts off the sensory channel bringing the aversive stimuli.  This arrests the development of that sense and can lead to difficulties with the different senses and motor operations working together;
• Under-registers the stimuli, and, once intentional motor behavior develops, the IP becomes preoccupied with seeking out the stimuli in order to maintain or regulate arousal (behavior is characterized by seeking automatic positive reinforcement).
• Reacts rather than responds – especially in emotionally charged situations.  IP’s with explosive and catastrophic reactions to stress have not mastered this level.

Name of Stage: Rhythmicity and Beginning Tracking and Monitoring

Characteristics: “…Rhythmicity is the beginning of Motor organization and the primary piece of motor planning and sequencing.”  (Greenspan, 2010)

This stage marks the infant’s first control over movement and allows the IP to use movement to regulate (seek or avoid) sensory input.  Motor actions such as the movement of ocular-motor muscles to focus the eyes on a stimulus; internal muscles in the ear focus the internal [hearing] apparati like radar dishes toward sound; the baby’s head and neck allow the following of a stimulus as it moves through the environment.  For human infants, the most interesting stimulus is the human face – especially the faces of their most familiar caregivers.  As they develop sufficient controls – usually in the first few months, to ‘fix and follow’ focus on a stimulus for short periods of time – even after they disappear temporarily behind barriers.

Achievements by the End of the Stage: “Rhythmic motion progresses from instinctual to purposeful, [and] the driving factor is emotion.” (Greenspan, 2010)  The baby is able to harness movement in order to fix his or her focus upon and follow stimuli, which enables the first perceptions of shape, color, movement, etc. to develop.

Emotion is expressed in behaviors that show interest, excitement, distress or aversion.  Turning towards and turning away are the most overt signs that among the output processes developing are the ones the govern attention.  The baby is also to show clear manifestations of their attention and emotions in their behavioral response – which are no longer random.  They can smile and squeal in delight and cry in distress.

Emotions decide what is interesting and therefore what to fix, focus and follow.  This is what Greenspan calls “Engagement with the World.” The depth and profitability of engagement has to do with the relative development of the underlying sensory apparati and the degree of control the IP has over the movements needed to explore the world by noticing, focusing upon, and following stimuli.  Since this stage occurs in the early months of life in typical development, purposeful movement is limited mainly to the eyes, head and neck.

Behaviors Associated with Deficient Mastery of the Stage: On the input side, the IP must be able to sense the presence and change of stimuli.  On the output side, the IP must be able to control movement to do the work of finding and fixing attention and maintaining attention to follow stimuli as it moves or changes.  Following stimuli yields an education in all kinds of things that have to do with how the world of objects and people works.

“…Babies who have delays in the development of their nervous system – because of oxygen loss of birth or some other biological challenge – often have a delay in forming this synchrony and engagement with the world. Their movements are more random.  As they grow, their rhythm and timing continue to be less rather than more predictable.” (Greenspan, 2010)

Difficulties in this area can remain as relative inattention to environmental events (Inattentional Blindness) and/or failure to detect changes going on in the environment (Change Blindness).

Inattentional Blindness is characterized by failing to notice unexpected objects and events that occur in full view.  This is usually due to the person’s attention being usurped by something else.  For instance, a person absorbed in a computer task may fail to notice people entering or leaving the room.

In the case of serious problems with attention, as in ADHD/ADD or Autism Spectrum disorders, this can occur regularly or as soon as the person fixes her focus on one thing.  When interested in a selected stimulus, the person becomes under-vigilant of the world and stops tracking and monitoring changes around them.  Cascading effects over time can result in:

• poor ability to notice unexpected events;
• failure to develop expectations of change or the possibility of unexpected events;
• failure to develop conceptions of intentionality inferred from trajectories of movement, and subsequent difficulties predicting changes or developing intuitions about change, and possibly;
• failure to discriminate meaningful changes from irrelevant ones.

Change blindness can further result not only not noticing relevant stimuli, but failure to form representations of stimuli before and after changes occur.  The IP can miss rather large or significant changes, such as the change in a person’s facial expression.  That would require the retention of a mental representation of the person’s face before the event occurred, noticing and following the environmental event that resulted in the change of emotional expression on the other person’s face, and the ability to connect the change in the person’s expression logically to the event that occurred.

Tommy and Maria are playing on the carpet next to each other.  Tommy is happily making a block tower.  Sylvia walks by and knocks it over.  Tommy starts to cry and tries to hit Sylvia.

Maria noticed Tommy happily playing with the blocks.  She noticed what Sylvia did.  She continued paying attention (what we refer to as ‘tracking and monitoring’ the events unfolding) as Tommy reacted with hurt and anger, changing not only his facial expression from happy to angry, but also giving most observers to conclude that Tommy’s behavior was a reaction to what Sylvia did.  From observing this ‘chain of events,’ Maria learns a lesson about emotional cause and effect (i.e. Tommy liked what he was doing and knocking over his blocks made him angry; without anything happening directly to her, Maria had an opportunity to learn that Tommy can react this way.  Further observations of similar events eventually results in Maria developing a concept – that if you ruin what someone is doing, they can get angry.

It is so important to understand that our notions of behavior or emotional cause and effect form mostly in this way – through observations mainly, as well as through direct, personal experience.  The failure to notice unexpected events leads to little notice of anything in the environment (inattentional blindness; under-vigilance).  Change blindness can be an obstacle to developing intuitions and concepts about people’s intentions and perspectives, and later on, a subsequent difficulty developing higher forms of logical thinking such as inferential reasoning.

Further, chronic inattention to change can have an arresting effect on the development of visual memory, visual-sequential memory and the ability to “visualize” descriptions of events.  This has serious implications for the development of abilities to follow directions and to develop listening and reading comprehension.  If these traits share a functional relationship to the behavior under assessment, then they are remarkable in this section and should be mentioned as an antecedent setting condition for that behavior.  Look for:

• Difficulty or chronic failure to detect changes or new events in the environment;
• Difficulties remembering conditions before the change;
• Difficulties perceiving and remembering changes from one moment to the next;
• Difficulties anticipating how events will unfold;
• Difficulties inferring intentions of others based on observing their movements;
• Difficulties understanding behavioral or emotional cause and effect.

Name of Stage: Connecting Affect to Motor Planning

Characteristics:  The person develops the ability to form an intention and then to organize the actions necessary to pursue their own goal.  Actions appear purposeful, organized, and flexible enough to deal with the inevitable differences each time the same action plan is enacted.  The person’s behaviors are consistent with their goals, and their behavior is coordinated and organized well enough to minimize frustration and maximize one’s drive towards mastery (as noted by continued and obviously pleasurable exploration and persistence).

Achievements by the End of the Stage: Engagement, emotion, motor planning, and sequencing all begin to work together in a way expected for one’s age and environment.  Different sensory and motor processors are learning to work together (e.g., eye/hand coordination).  Perceptions either match or do not (e.g., the eyes note an object at a certain distance.  When the person reaches for the object, the distance one has to extend one’s arm [and the feedback from that reaching movement] agrees with what the eyes see.

Behaviors Associated with Deficient Mastery of the Stage: If visual and motor perceptions do not match for instance, the person may reach for objects while looking away; or when looking at an object, their reaching behavior will be tenuous – as if the person cannot trust their eyes).  Senses and motor output feedback do not match or integrate in some or most combinations, and motor plans become stunted, rigid, and repetitive.  In severe cases resulting in autism spectrum disorders, motor plans loop and the behavior itself appears to be the reinforcing consequence (automatic reinforcement).

Keep in mind that Greenspan defines autism and pervasive developmental disorders by the relative difficulties a person has connecting affect (the desire, intention or idea to do something), and executing the steps necessary to solve that goal.  He calls this the Affect Diathesis Model of Autism.  Look for:

• play and behavior characterized by repetition of the same one or few steps, such as lining up objects;
• fixed, rigid and invariant play scripts that loop (the same steps repeating over and over), and;
• difficulties accommodating to new information

Name of Stage: Connecting Motor Planning to Interaction and Communication

Characteristics: The person can engage in extended sequences of interaction with another person or with an object that provides variable responses.  This stage is about developing the ability to form such a smooth and efficient connection between intake (sensation, perception, retention) and behavioral responding or output that engagement in sustained, long chains of interaction with a constantly changing object or person is possible.  Exploration behavior is marked by theme and variation.  The person remembers the properties of objects or the characteristics of people and responds in real time to their behavior.

Achievements by the End of the Stage: Purposeful actions gradually expand from one or two-step sequences to four or five step ones.  

By nine months of age, babies can look at Mommy’s face, reach for the colorful balls she is holding, take the ball, examine it, handed back to her, and then – if mommy hides the ball in her hand – search for its hiding place. These are purposeful, sequential, slowing actions that respond to the mother’s actions in fulfilling emotional need. The baby is communicating through reciprocal actions, as in playful, giggly games of Peek-a-Boo. (Greenspan, 2010)

Not only can the person realize their intentions by enacting several steps, they can deal with changing input during the course of their actions.

For instance, a person may want to walk in the door, but realizes that it is locked.  She then goes to another room to fetch the key and to open the door.  She remembers to return the key to the place where it belongs, and then resumes the steps towards her original goal.

The above example demonstrates how a desire or affect remains “on-line” as the person carries out the necessary steps, deals with distractions or unexpected sources of input or change, and solves problems on the way to realizing the intent.

It is very important to note that typically developing, emotionally healthy and attached children will show their longest, most sustained and variant motor planning abilities in their interpersonal caregivers.  This has a lot to do with the scaffolding adults provide, but the desire is internal and comes from those early exchanges heavily reinforced by positive responses (in the form of smiles and other forms of positive attention).

For the Greenspan’s, sustaining long, back-and-forth gesturing, is significant.  They’re not alone.  Most researchers agree that these early exchanges form the foundations for all other social interaction (and subsequently, the person’s capacity for social thinking and social development).  These early exchanges and the subsequent interest in people that leads to developing interest and skills for “tracking and monitoring” social behavior, establishes the foundations

For more about the importance of “Tracking and Monitoring” and its role in developing intersubjectivity… click here.  Indeed, difficulty sustaining long chains or sequences of reciprocal social interaction is a prime factor in the deviant pathway of autistic development (see below).  It is the reciprocity and spontaneity of social interaction that depends on quick, efficient and synchronous neural processing.

Behaviors Associated with Deficient Mastery of the Stage: A processing deficit anywhere in the networks of circuits recruited by the brain to manage the constantly changing input and the constant demand for timely and appropriate responding can preclude or interfere with full participation in social interaction.  Children with these deficits are very likely to turn away from reciprocal social interaction, remain on the periphery of play or show no interest in others at all, or, they adopt inflexible and controlling ways of controlling social interactions that end up in “one-way streets.”

Here the Greenspans remark on early development and the possibilities of accumulating and cascading deficits over developmental time,

“Many children with dyspraxia – the formal term for problems with planning and completing motor tasks – tune out at this stage because they can’t organize purposeful reactions.

Parents of children with these problems may remember difficulties at this stage. If children can’t get into a rhythm with another person, they don’t get pulled into a strong relationship. I would estimate that at least 50% children with moderate to severe motor planning problems are not good at such continuous communication. Later these children may be given the label of “inattentive” or that of ADHD/ADD. The problem may have started at this point, when these motor planning or sensory difficulties interfered with their being drawn into an engaging, focus relationship. One sees this most profound with children who were on the autistic spectrum. They repeat the same one- or two-step actions – such as putting toy cars in a row – because they can’t plan more complicated sequences or establish more personal connections.”

Behavioral issues relative to this stage have to do with the IP’s abilities to engage in and sustain long chains of [truly] reciprocal social interaction.  Look for:

• Tends to avoid dynamic or open systems.  Prefers static, ultimately predictable sequences already learned.
• Tends to remain on the periphery of play and social interaction and cannot engage in reciprocal and dynamic, spontaneous interaction for very long.  If the interaction goes on too long, the IP will either avoid or leave, or try to “take over” and control the interaction.  If that doesn’t work, the person may simply go on without noting or “taking in” the feedback of others – leading to monologous “interaction.”
• Easily loses place; does not shift attention from own activities to environmental events (change blindness); does not stop to track the unfolding of events
• Does not pay attention long enough to sequences around them to learn “cause and effect.”
• Social interactions are of very short quality and are only for instrumental purposes (e.g., making a request; protesting; asking or answering a question, etc. – what are known as imperative forms of communication).
• The person avoids social interaction
• If social interaction is not heavily supported by a skilled partner, it terminates; the person is unable to “repair” minor breakdowns in communication through devices of rephrasing, clarifying, adding gestures, etc.  There is a dearth of skills on the person’s part to keep interaction going; they may lapse into repetitive scripting or monologues
• The person also has short engagements with objects consisting of only a few steps; when a problem occurs, they may give up or try repeating the same action invariantly

Name of Stage: Shared Problem-Solving

Characteristics: Now that the person can engage in basic reciprocal behavior, understanding (receptive) and communication (expressive) both work together for the purposes of co-regulation.  That is, the person is able to use communication, gestures and actions to solve problems along with others.  This requires being able to ‘read’ the behaviors of the other person as well as to be in control of one’s own actions simultaneously.  The Greenspans call this “multistep communication” where the child is able to combine thoughts, actions and communication in “…an orderly, connected (rather than free associative or random) sequence …[that] clearly addresses the problem …” (Greenspan S. a., 2010)

Achievements by the End of the Stage: The person can evaluate and modulate their own actions to a certain degree to convey different nuances and qualities, and they can perceive qualities of other’s actions – not just the mere shape or result of them (moves from Meltzoff’s “emulation” to true “imitation” type learning), but the style and intention behind them.

The Greenspans describe the processing demands of co-regulation… “When you need someone’s help in solving the problem, you watch for that person’s response. Whatever response you receive, anything from pleasure to surprise to your ability, affects how you plan your next step. So, unless the other person is unusually consistent, you are constantly challenged to create a new approach.”

This is a good place to look at Andrew Meltzoff’s taxonomy of imitation. That is because to be truly and reciprocally engaged with another person, especially for shared problem solving, one must be able to notice and follow movements or even imitate them, but to be able to infer the intention behind the other person’s actions.  The following is an example of how we infer intentionality simply by watching and comparing with our own experience: We’re watching people hammer nails into pieces of wood.

Person A is swinging the hammer and hitting the nail head very hard.  The style or “attitude” of ‘swinging very hard’ is different from light tapping of the hammer on the nail.  The “shape” of the action is the same – a hammer being swung by a person and hitting the nail on the head.

When we observe Person A we can observe:

• At the level of “Emulation:” The “emulator” observes that the hammer swings through the air.
• At the level of “Imitation:” The imitator observes the style of the action.  That Person A is swinging the hammer with a high level of velocity and force.  The imitator cannot infer why ‘hard swing’ is necessary, but they can observe the differences of style and attitude between hard and swinging and hitting, and light tapping of the nail
• At the level “Identification” (Meltzoff’s ‘_Like Me’): The identifier compares her own experience with hammers, wood and nails.  The hammerer is “like her” and therefore does things with intention or a goal, and that the style or attitude of the action is also meaningful.  She is able to inferfrom Person A’s hard swinging that:
  • Above all – the person intends to drive the nail into the wood
  • The person is trying to connect the wood to something else (because we can see that the nail goes through both objects); if the person were driving a nail into a wall, we might assume that the nail is to function as a hook and that is what the person intends to do
  • The person is angry and is taking out his aggression on the nail (unlikely because experience would tell us that this could destroy the wood)
  • The wood is very hard and requires more force to drive the nail into it
  • The person is swinging too hard and might damage the wood

There is obvious potential for error when we make interpretations from such information, but that is how social cognition works.  Social cognition involves forming hypotheses about others based on observations of their behavior at the level of the motion itself, style or attitude, and inferred intent. Further interaction allows us to determine the correctness of our assumptions and inferences.

Person B is tapping the nail gingerly into the wood…

• The emulator and imitator derive essentially the same meaning from the observation, but the imitator could at least imitate the style or attitude as well as the shape of the motion (whereas the emulator would only be able to perform the shape of the motion).

Those that work with the severely disabled or severely autistic frequently observe that their Students have difficulties learning to clean things.  They don’t understand the purpose of the action so they don’t apply the correct amount of force.  And more importantly, they cannot learn from a simple demonstration of the force by another person.

• The identifier is able to inferfrom Person B’s delicate handling of the hammer that:
  • The person intends to drive the nail into the wood
  • The person is trying to connect the wood to something else
  • The person is afraid to swing harder
  • The wood is very soft or brittle and requires more care to put a nail into it
  • The person is swinging too soft and might not be able to accomplish his goal

The point of this momentary diversion into the social cognition of imitation is to show that when two people interact to solve a problem (or to have any type of social interaction), they not only respond to the other’s actions – they respond to their perceptions of other’s actions.  Developing a perception, inference or concept of the other person’s interactive responses becomes necessary at this stage of motor planning.

Behaviors Associated with Deficient Mastery of the Stage: The IP has difficulties coordinating simple actions with others (gets out-of-sync; goes too fast or too slow; doesn’t pay attention to changes).  They also have problems interpreting the attitude or intention of others’ actions and chronically misperceive the context of their interactive partners’ words and actions.  Look for:

• The person misses the tonal context of interaction.  They are a tonal mismatch with their partners, going too fast, too slow, too much, too little, too excited, not interested or curious as others are, etc.  They cannot be truly in-sync with others and it is noticeable to neurotypical peers
• The person chronically misperceives the intentions of others
• The person cannot tell how people feel about his or her behavior
• The person cannot tell how people feel about their own behavior
• They have difficulties participating in chores or tasks together where each person’s role depends on the actions of the other person.

EXECUTIVE FUNCTIONING: ORGANIZING THOUGHTS

Beginning in the second year, children go beyond forming intentions and acting on them, and beyond simple sharing and problem solving.  The levels of planning and sequencing higher up in the hierarchy of the taxonomy of motor planning and sequencing focus more on “…the planning and sequencing of ideas that direct the movement [italics mine] rather than the movement itself.” (Greenspan S. a., 2010)

At the executive systems level, children begin to work with multiple thoughts.  They can mentalize (represent and act on internally in the mind) ideas and the actions involved, imagine the consequences and effects, anticipate the consequences and pre-plan problem-solving, evaluate their own actions and motivations and those of others, etc.  It is a stage where the mind can function well in advance or absent of any overt physical action.  The body does not have to do what the mind thinks, so inhibition and deferring action is now possible.  Importantly, one can imagine something and then, with new information and thinking, re-imagine.  They can think about a sequence of actions they might take, and re-sequence them if need be.

The executive system cannot do its job properly if it has to work with poorly processed perceptual and movement information. So in this sense, executive function is at the top end of the hierarchy of the taxonomy of motor planning and sequencing.   Stanley Greenspan refers to executive processing systems as the “Orchestra Conductor,” (Greenspan & Benderly, 1998), which I prefer.  In this analogy, if each of the individual processors are like individual instruments of the orchestra – each capable of its own range, type, quality and intensity of product, the executive’s job is to get them to work together for the purposes of making complex decisions.

I would add that just like any other neurological process, executive functioning is carried out by ad hoc assemblies of neurons recruited for the purposes of accomplishing a goal or solving a problem.  So there is no single place where this “Orchestra Conductor” can be found – no seat of the soul or homunculus.

We also know that this “binding of perception and movement also occurs at different, more elemental stages of processing in the basal ganglia, cerebellum and thalamic/limbic regions of the brain (Koziol & Budding, 2010).  Koziol and Budding point out that the role of an executive system to make decisions and that this happens not only in the systems commonly referred to as “executive” but also and importantly at various levels beneath consciousness.

In “The Learning Tree,” the Greenspans use the analogy of a tree, where the roots of the tree function as the basic uptake or perceptual systems and where the trunk organizes the basic integration of perception and movement of the body system, the branching (elaboration and full fruition of the system) represented by executive processes requires a well-functioning root and trunk system.

Executive Function encompasses the following types of hierarchical processing:

• Imagining (forming ideas) and re-imagining ideas (thinking about an idea in different ways; mentally rehearsing the steps internally
• Sequencing and resequencing of ideas (when an original sequence of actions cannot be carried out, the person can rearrange the events mentally before carrying out the new sequence
• Separating covert thought from overt action; being able to think about actions and imagine the outcome of those actions without taking them (rehearse internally in the mind)
• Find connections between ideas (abstract reasoning)
• Engage in hypothetical thinking and think about variables that cannot be seen or detected through the senses
• Understand and separate perception from fact or reality

The above is certainly not an exhaustive list of what the “executive mind” does or can do.  The list is some of the more important aspects of executive function that begin forming in the second year of life and continue to grow in complexity and elaboration through the life span.

For our purposes here, we are looking at how the executive system makes use of attention, emotional and social cognition, cognitive, language and symbol and movement representations (representations are the products of neural processing) to coordinate behavior.  The levels of mental organization, planning and sequencing described below are multilayered and complex.  The executive system allows us to form composite or aggregated representations of the world and is the gatekeeper for the window of consciousness.

Name of Stage: Representing Ideas with Symbols

Characteristics: Movements and ideas can now be represented by words, pictures, specific gestures (such as mime-like gestures) for the purposes not only of communicating, but of thinking. Inner language develops that can be used for rehearsal in place of actual moving.

Children first use complex symbols (words to express needs and thoughts in their third and fourth years. A 24 month old might scribble scrabble with the crayon but isn’t that the level of ideas yet. When a child makes kind of a circle with dots and that looks sort of like a face and says, “That’s MOMMY,” than she has moved into the realm of creating meaningful ideas.

Achievements by the End of the Stage: Language, especially inner language, increasingly controls behavior.  Inner dialog plans and anticipates the consequences of actions.  It allows the child to think about something and not do it.

Behaviors Associated with Deficient Mastery of the Stage: Inner dialogue keeps us on track with our intentions.  It keeps our behavior consistent with our goals.

• Behavior appears to be stimulus driven rather than “plan-driven.”  At this stage, the person easily forms goals and can take actions consistent with them – but they are easily thrown off from their motor plans.  The person is easily distracted from his or her original intentions by changes in the environment.  Seeing something new causes them to drop their previous train of thought and embark on a new one.  It appears that the person gets his or her ideas from the environment, and not from a solid goal developed in the mind with actions disciplined enough to stay ‘on course’ with the original goal.
• The person acts before thinking; there is a notable absence of signs of thinking and anticipating before acting
• The person does not change or ‘repair’ their actions when they receive negative feedback.  This requires the simulation of the interaction inside the mind: replaying the different sides (or roles) in the interaction in an internal dialog to try to understand what happened and what to change.

Name of Stage: Logical Thinking

Characteristics:  Ideas begin to flow in sequentially connected, narrative form.  The IP understands cause and effect on different levels, depending on the person’s ability.  Ideas and the actions that follow become connected by reasoning.

They can also think backwards.  The glass is full because someone filled it up and put it there.  That soda belongs to that person because she walked in with it and she is the one that drank from it and placed it next to her when she sat down.

When relating events, the person gives the listener reasons for why things happened (“I came inside because it was too noisy;” “She went to see Batman because she likes Batman movies.” He went in there because it is the ‘Boys’ bathroom.”).

We can also see logical action sequencing develop as a child’s drawings become stick figures of family or friends – human figures with multiple parts, added one by one. At the same time, the child learns to make letters and numbers too, sequencing shapes together in meaningful ways…

…Simple conversations about everyday events also add to planning and sequencing. She draws on her ideas to plan what she wants, and her eyes, ears, and hands to carry out the plans, all in logical order and packing lunch, she and her mother talk about shapes – a round Apple, a rectangular box of juice, a triangular half of the sandwich. This girl is more likely to remember all this and repetitive non-expressive activities, such as flashcards work the shapes order, used to memorize shapes.

Rules represent connections of ideas.  They are connected to reasons (why the rules are needed) and the consequences.

They realize that the other person’s actions are because they are trying to win, or trying to help, etc.  This leads to the ability to form mutual, “team” goals and to share and distribute effort. Children can participate in more complicated games and activities and adopt a “group ego.”

Achievements by the End of the Stage: The individual develops notions and concepts of why things happen.  This of course, applies to behavior as well, but people are complex objects.  The “why’s of people’s behavior” is field of psychology, and you are reading this because you seek to advance your logical thinking abilities in this area.

We continue to refine and elaborate upon our logical thinking through the life span, but it starts with a basic understanding that phenomena have causes.  You see in the IP’s words and actions consideration of “what if…” or “what happened when…” in the overall organization of their actions.

Mastery of the stage will also require the ability to understand how action sequences unfold – through causes and effects – actions and reactions… into a “narrative.”  Logical thinking is a necessary part of listening and other forms of “comprehension.”

In school, goals are often driven by the curriculum rather than by their meaning, importance, or even possibility for the individual.  One of the most common IEP mistakes is to expect Students to derive meaning from written or spoken narratives when they cannot even tell you what happened to them five minutes ago.  These Students are given to using imperative forms of language almost exclusively and if they do share their experience or observations – it is limited to the here and now.  If asked, they ‘may’ be able to answer questions about what happened by reciting a list of unrelated events (e.g., “I ate lunch.  They had hot dogs and tater tots.  I sat next to Alice.”)

This is not a narrative – it is barely experience-sharing.  Nevertheless, they are assigned goals to learn to “answer questions and give information about stories at the 6^th grade level…”  This Student needs to be able to explain why something happened in the present – perhaps excluding any subjective reasons (“They turned on the light because it was dark;” “They came inside because it started raining…” “They didn’t eat those because they were full.”)

Behaviors Associated with Deficient Mastery of the Stage:

• For individuals with developmentally-based intellectual limitations, you see that they do not try different behaviors when original efforts fail.  They simply repeat the same actions.  There is little evidence of thinking about what might happen in order to find new solutions
• In play or communication, you also see repetition with little variation or elaboration.  For instance, the individual rolls the car around, but it doesn’t go anywhere, drive to any place in particular; do anything once it gets there, etc.  A child with mastery of this stage will have the car go somewhere (store), do something (get some food), etc.  This could go on to become quite long sequences of what is essentially narrative in play.  Events unfold and bring on other ones.  Children continue to elaborate their narratives with emotional causes and effects (e.g., they need to go to the store to pick up food for dinner; then they go on to play “dinner” and then maybe wash the dishes, get ready for bed, etc.).In communication, you tend to get what I call “the titles without the movie.”  This is simply a list of events that occurred (e.g., “I ate lunch.  I ate hot dogs and tater tots.  I sat next to Alice.”).  Much of this has to be elicited by adults – but this is mere labeling of events.  It is not communication, and certainly not narrative.  AND IT CERTAINLY IS NOT ANYTHING LIKE REAL LISTENING OR READING COMPREHENSION!

The following of Greenspan’s stages overlap considerably with social and emotional cognition (it’s not as if the above forms of thinking aren’t inseparably tied with the emotional functions of the brain, but the higher levels of thinking are very heavily influenced by emotional intelligence.  In fact, they define the person’s extant emotional intelligence. They involve “emotional concepts” such as choosing options based on what one “feels” and “thinks” is better or best; thinking in terms of relative value and gray area thinking, and being able to think about one’s own thinking (reflection, metacognition and other types of formal operational thinking)…

Name of Stage: Choice in Planning and Sequencing

Characteristics: The IP shows evidence of “repair of ideas.”  They begin by understanding that there is more than one way to do things.  When something doesn’t work or is not preferred, they can think of other action sequences to solve the problem (repair).

As children start thinking at this level (typically between the ages of four and six), they begin realizing that there are multiple places to put that dollhouse bathroom so it is near the bedroom, and multiple places for the bridge over the river, and multiple ways to build the bridge. Many reasons, many methods. This realization is a big advance for a child because now she can consider more than one idea how to do something in more than one idea as an explanation. Later shall be able to mull over different ways to prove a point in passing. She has choices. With this understanding and improve planning and sequencing abilities, children experience a taste of freedom.

Take Harry, who is learning to play softball. He learns that if he’s on base and the batter hits a pop-up ball, he probably should wait to run to the next base. Otherwise, he should take off as soon as the ball is hit. And he learns that when he’s it back, he can swing hard, bunt, or choose not to swing. Soon, when asked, he can give multiple reasons why different actions have different outcomes.  A wider range of ideas comes into his head and gives him more choice, flexibility, and creativity in his actions.  Advances in sequencing ideas and actions increase the complexity of Harry’s logical thinking. (Greenspan S. a., 2010)

Achievements by the End of the Stage: The IP should be able to think in terms of multiple alternatives, if not multiple and complex causes and effects.  Play and communication include not only coherent themes and topics but variation and invention.

Behaviors Associated with Deficient Mastery of the Stage: The IP’s behavior is characterized by mental and behavioral inflexibility.

• Difficulties organizing and following through on tasks
• Difficulties with logical thinking that must incorporate multiple causes and effects.
• The person has a difficult time remembering or relating a coherent sequence of events.  This presents real problems for listening and reading comprehension, and explaining of one’s own thinking or actions.
• The person often fails to understand one’s own role in the consequences of their behavior – usually because of difficulties understanding the impact of their behavior on the environment.Sociopaths show this simple form of logical reasoning: “I took it because I wanted it.” But more common is behavior that shows a lack of perspective taking and a lack of understanding of the possible unseen consequences of behavior. Also more common, is the belief system that others cause one to act (e.g., I hit him because he made me mad).  They do not really think in terms of more than one logical alternative.  In such a case, there are no other logical sequences that they can think of.
• Black and white thinking based on “should” instead of real consideration of alternative forms of logic.

Name of Stage: Comparative and Gray-Area Thinking

Characteristics:  New skills of comparison by degree or “relative thinking” emerge.  This corresponds to Meltzoff’s level of “Imitation,” where the person can perceive and perform actions with varying styles, degrees of intensity, etc.  They also begin to understand and communicate in terms of degrees of emotion (i.e. “that made me a little sad, but not that much;” “She’s more popular than me” “writing is easy for me but I’m not so good at drawing”).  Not surprisingly, it also corresponds (both age-chronologically and in meaning) with Erik Erikson’s psychosocial stage of “Industry vs. Inferiority, where children begin to compare their own abilities to others.  The suffixes “er” and “est” enter the vocabulary.

At the simplest levels, individuals can see more and less, as well as gradations in physical objects according to easy to understand dimensions of size (from shortest to longest; ), color (lighter/darker; red, redder), intensity (e.g., hardest, softest) sound (e.g., louder, loudest), speed (e.g., fast, faster, fastest).  We know there is dimensionality of this sort in all of our sensory perceptual systems.  This simple sort of comparison was termed, “seriation” by Piaget.

Achievements by the End of the Stage: The higher forms of the stage involve understanding shades of gray, such as degrees of rightness or wrongness; the difference between a white-lie and a malicious one; acquaintances, friends, good friends, best friends, etc.  They begin to understand that there may be more than one right answer and that some answers may be more or less correct than others.

Understanding degrees of difference allows children to make judgments and organize their actions in an effective way. Eventually these skills will help the child plan a debate or a book report, recognizing that point she can make different levels of importance to her argument (Greenspan S. a., 2010).

Here again, we see a lifelong developmental strand that starts simple but can go to levels of enormous complexity.

Behaviors Associated with Deficient Mastery of the Stage: There is a general dearth of ‘relative thinking.’  Think tends to be black and white and there is a lack nuance to understanding, communication and action.

• The person has difficulty reading intentions (Greenspan’s example: Being able to make subtle comparisons and act accordingly left a child better understand when a friend is wrestling with him just to fool around or in earnest because the friend is mad about losing a game).
• The individual’s thinking shows an all or nothing quality.
  • The individual has difficulty assessing how hard or easy a task will be
  • The individual has difficulty understanding the seriousness of consequences
  • Their understanding of emotions reflects polarized emotions (e.g., “My Teacher hates me.”). The individual has difficulty judging whether others are slightly or very angry for instance.
  • Their expression of emotions also reflects such polarization.

Individuals experiencing personality disorders display a phenomenon called “splitting,” where, because of their inability to “conserve” the essence of a person as stable (Kohut’s “libidinal object constancy” for those familiar with object relations psychology), a person can go from being “all good” to “all bad.”  It is normal for a young 4 year old to “hate Mommy” when she denies him a cookie before dinner, and have the ‘best Mommy in the whole world’ later that night when she lets him stay up a little later that evening.

Many in the ED population are diagnosed with “Conduct-” or “Oppositional Defiant” disorders. These, if not remediated, are likely to be later diagnosed as some sort of personality disorder.  The risk gets greater as the individual gets older and the environments don’t change and he or she receives no intervention.

I happen to believe (as many psychologists do) that ODD and CD are nascent personality disorders, but the tradition in psychiatry is that children are still malleable and can change from this pathway.  Very true.  But the difference between a 17 y.o. and 11 month person with a conduct disorder and the same person at 18 is merely a birthday.

• The person’s actions also reflect an all or nothing quality.  Their emotions can go from neutral to explosive or giddy in ways expected of infants (going from one extreme to another quickly and suddenly).

Name of Stage: Reflective Thinking

Characteristics: “…planning one’s actions or sequencing ideas is based on an internal communication with some inner standard. A child can judge her own essay or design with and reflect on it as she plans the next steps. She can also reflect upon the effects that her arguments or actions will have on others with whom she has a close relationship. This is an important asset because the comparative and gray-area thinking that she has learned can lead to many disagreements.” (Greenspan S. a., 2010).

Achievements by the End of the Stage:  The individual can see many sides of the same issue.  Because a person thinks or feels differently, or has another experience of the same thing, it doesn’t necessarily mean that the other person is completely right or wrong.  Compromise is possible at complex levels.  The IP is able to understand his or her own point of view as well as those of others and can engage in negotiation, peaceful argument and logical debate.

“Take, for instance, haggling over rules. The umpire says, “Three strikes and you’re out,” and the batter answers, “But that wasn’t a real swing!” Rules have interpretations and nuances; rarely are judgments black and white. A child realizes that she can either follow the rules; try to change the rules within the structure of the game; or point out other interpretations, which will often lead, initially, to disputes. Settling disputes requires reflecting upon alternatives and planning a resolution with an understanding of where both sides are coming from.

Self-reflection and self-evaluation work the same way, whether designing a computer game, building models, and writing essays or stories. The writer or designer plans elements ahead of time, reflects on them, carries them out, and then evaluates what she’s done. In essay writing, children who have reached this stage can now diagram a logical argument (the main point and the supporting points) and then evaluate how strongly they make the case. They can put on the opponent’s hat and argue against themselves in order to find and address any weak points. This strengthens logical sequencing and organizing along with self-evaluation. (Greenspan S. a., 2010)

Behaviors Associated with Deficient Mastery of the Stage:

• Difficulties or insufficiencies in this area
• The IP has difficulty dealing with ambiguity
• The IP shows difficulty or inflexibility with moral thinking and judgment; there appears to be no constancy of standards; the IP behaves according to the rules only if they think they will get caught or punished (this is no different than some people’s concept of ‘sin,’ where the deity is always watching.  These people are different from those that understand why we have a particular code or standard of conduct)).
• The IP engages in coercive behaviors when others don’t agree, instead of carefully considering perspectives and other relative factors
• The IP has little understanding of the greater good and can be very narcissistic

This would be a good place to discuss Lawrence Kohlberg’s taxonomy of moral thinking and Erik Erikson’s taxonomy of psychosocial thinking, but that is beyond the scope of this chapter.  I highly recommend reading more about these.

Mental and Cultural Tools
Lev Vygotsky’s Taxonomy

Lev Vygotsky, a Russian psychologist of the mid-20^th century (and a rough contemporary of Piaget: their theories are often compared and contrasted), looked at the social and cultural aspects of learning.  For the purposes of our analyses of cognitive behavior and capacities, we look at “”pivotal” or “learning how to learn” skills:”  Those skills sets that once mastered, enable mastery of skills outside of the original learning environment.  For instance, learning to use a screwdriver – a mechanical tool – in one situation might lead to being able to drive many types of different screws.  It also makes learning how to use similarly working objects such as wrenches easier.

We also look at how learning tools can be used as measures of predisposition for learning.  For instance, a child that has trouble with motor imitation will have trouble learning simply by watching others perform actions.  The child that has not developed inner language is expected to have difficulties with thinking before acting and other forms of mental rehearsal.

Vygotsky’s greatest contribution was identifying and emphasizing the inter-dependence of learning in typical human development.  He maintained that intelligence is “co-constructed” when more able individuals (teachers, masters) engage with less able individuals (learners, apprentices) in the performance of tasks and problem-solving.  In the process of engaging in tasks and problem-solving together (Guided Participation Teaching), the “Guide” provides support (“scaffolding” [Bruner]), and, as the learner gains competence, the Guide gradually “transfers responsibility” to the learner.

The reciprocal nature of the social situation of development means that school readiness is formed during the first months of schooling and not prior to school entry. Children adjust to the new demands of school as they participate in school. They cannot learn to adjust out of that context.  (Bodrova & Leong, 2005)

In the beginning stages of Guided Participation teaching, the concepts and the skills involved in learning are formed in a gradual transition from “inter-individual” or “inter-mental” phases, where the learner relies heavily on the superior toolbox of the Guide, to phases where the mental tools become internalized (intra-mental) and independent in the individual.

Vygotsky’s observations of how individuals acquire learning through cultural means has been confirmed many times over by cultural anthropologists Barbara Rogoff and David Lancy most notably, primatologists (most notably Simon Baron-Cohen), and developmental psychologists (most notably Jerome Bruner) and educators Elena Bodrova and Deborah Leong.

Guided Participation Teaching is the way we evolved to transfer mental skills to our children and the way children evolved to learn.  Modern didactic approaches that are separated from the context in which the skills need to be understood and applied (e.g., textbooks; worksheets) are relatively very new in human history (about 250 years old), and do not work for many children.  Didactic and imperative approaches almost universally used in this country are easier to use with large groups of children, but they are the reason for a lot of frustrated education and behavior problems.  To read more about Guided Participation Teaching in general, as well as Steven Gutstein’s adaptation of the theory to intervention for autism click here.

Another major contribution from Vygotsky is the concept of the “Zone of Proximal Development.”  The ZPD is a range of skills just beyond the IP’s current capacities for independent function.  Vygotsky referred to them as skills or competencies that are currently “under construction.”  The IP may possess some of the skill but cannot do it alone. Or, he or she may be able to perform the skill with some other type of scaffolding.  Whatever is in the ZPD, it represents, to paraphrase Vygotsky, ‘where teaching must bring the child.’

As far as cognitive development (or any other form of learning) is concerned, Vygotsky wasn’t as specific about the specific behaviors to expect in each developmental stage.  He was more concerned about the social nature of the transfer of knowledge.  Four stages of the Zone of Proximal Development have been identified, which define a taxonomy of learning:

• Assisted Performance: The skill or subject is new and the IP requires significant help from a more knowledgeable Guide.
• Unassisted Performance: The IP can perform the skill or task without heavy reliance on the Guide, but the performance is not completely competent.  The person is prone to making mistakes and still has quite a few gaps in knowledge.
• Full Internalization: The IP can perform the skill or task without any reliance upon the Guide.  The Student has internalized the skills and performance is proficient.
• De-automization: This is what happens when the IP has lost skills for some reason that he or she once had.  This may be due to simple lack of practice or other reasons.  The IP will have to review or relearn the skill or subject matter to some extent.

For our purposes here – we are trying to determine whether the IP has the cognitive pre-requisites to adapt successfully to current environmental demands (or to learn a replacement skill for an inappropriate behavior).  We are also using this information to refine our baseline logic and to make the best choices for replacement skill targets.

The degree of competency in the IP’s current skill can be and is quite often the crux of the problem.  Current teaching may focus on skills in which the IP does not have the basic foundations to learn.  Teaching replacement skills will not be a simple matter of breaking lessons down into smaller steps. That can result in rote understanding and rote performance where there is no room to expand or elaborate on the skill.

Tools

In the abstract – a tool is not necessarily a physical thing.  Here, we are talking about mental skill sets that happen to be expressed and observed as actions and that function as means or ways of learning.  For the purposes of our analyses of cognitive skills related to the behaviors under assessment, we might look at any one or combination of such means as insufficient for adapted behavior.  The discrepancy that predisposes the behaviors of concern could very well be found in the lack of learning tools.  This is especially true when the functions of behavior are to avoid tasks or demands (social negative functions), or when the person’s social skills result in inappropriate forms of attention-getting (social positive functions).

The following are some of the tools identified by Vygotsky and his intellectual successors.  They represent not only cognitive, but emotional achievements.  Vygotsky did not provide us with a taxonomy as complete and delineated as Piaget or Greenspan.  To make up for this, I have added incremental steps that come from looking at Piagetian stages through the lens of Vygotskian concepts.  These are not official revisions of Vygotsky’s model at all.  Rather, in the spirit of finding sources to inform our baseline logic, I am merely attempting to improve our heuristic.

As always, we look for the mental tools the environmental requires, and compare that to the tools the IP has.  Discrepancies in this regard can be functionally related to the behaviors under assessment.  In this section, I describe the tools themselves and behaviors that seem to be more likely when the IP does not possess those tools.

The Development of Self-regulation: The IP demonstrates behavioral evidence that they can control their impulses, think through actions to some degree and to defer their own immediate goals in order follow others’ agendae.  Their actions are no longer solely governed by their impulses and immediate interest.

They move from the infant-toddler world view where “things start when I get interested and they are done when I am no longer interested.”  In older persons, we often see this trait expressed as difficulty controlling impulses, ballistic motor plans, difficulties with transitions or serious problems with motivation and follow-through when others make demands, or when the things don’t go their way.

In respect to the mental tool of self-regulation, we look for the cognitive concepts that underlie higher different aspects of “self-regulation” and goal deference.  Here are just a few:

• From Noticing to Attention: Being able to focus one’s attention and filter distractions is the very first purposeful act that a person can do. The newborn’s first ability is to be able to find something interesting and be able to attend to it.  Greenspans Stage 1 is about this.
  • The first thing that the newborn finds interesting is her mother’s face (faces in general). Interest in faces can be considered a cognitive tool.  The human face carries information.  The human face cannot be interpreted properly without look at the “gestalt” of the forehead, eyes, nose and mouth.  Separately, each of those facial parts cannot convey a signal.  They are only understood as singular facial expressions.  Therefore, the infant has to be able to use visuo-spatial intelligence to understand the gestalt of the human face – what the parts mean separately and as a whole.
    • Having the ability to take [at least momentary] pleasure and interest in stimuli is a tool
• Showing interest in different forms of sensory stimuli is a tool
• Becoming able to filter and modulate sensory input so that it is not overwhelming (and therefore, not avoided) is a tool
  • Any individual at any age that does not show interest in facial expressions is missing a vital tool for further social development.  They are unlikely to use the face as a reference point to determine how others feel; where their attention is focused (and subsequently what they’re probably thinking about) or their responses as feedback.
• Showing interest in faces is a tool
• Learning how faces can serve as a reference point and “feedback” is a tool set
  • Understanding facial expressions is a tool
  • Making simple associations between facial expressions and the sound of their voices as they say it (early basic emotion discrimination) is a tool that enables further learning about emotions
  • Understanding how to follow other people’s eyes as a window into their attention is a tool: you should at least know if someone is paying attention to you or not

Behavioral Evidence of Not Having or Using this Tool

• Has difficulty maintaining focus and attention due to understimulation by the environment: with corresponding lack of interest, pursuit and exploration
• Has difficulty maintaining focus and attention due to overstimulation by the environment: with corresponding distractibility and impulsivity
• Focus is at the mercy of novel stimuli (stimulus dependent)
• Has difficulty shifting attention from one action or idea to another
• Understimulated by faces: shows little interest, searching or attention to faces
• Overstimulated by faces: Turns away; avoids eye-contact; over-relies on peripheral vision; cocks head
• Does not scan faces or seek and use facial expressions as social information
• Has not established or has marked deficiencies in Joint Attention
  • From Actions to Intentions: This tool has to do with bringing one’s own physical actions under control, but it also has to do with understanding the actions of others.
    • Having the ability to take pleasure and interest in stimuli and to be able to follow it for several moments is a tool (to pay attention and to ignore other stimuli intentionally)
• Following an object or person as it moves and behaves in order to understand it’s patterns is a tool called “tracking”
• Following the object or person as it changes is called “monitoring”

Tracking and monitoring are the foundations of learning to predict, and later on, to be able to make inferences what might happen next (anticipation) or what the person or object will do from their pattern of behavior so far.  As far as people (and other animate objects) are concerned, actions in sequence imply their intentions or the further course of behavior.

• A person balls up a piece of paper and looks around. She stops scanning with her eyes once she spots the trash can.  She gets up and walks towards the trash can – what is she about to do?
• A person blows a soap bubble into the air.  It rises and eventually pops.  Some are bigger than others.  Some pop sooner or later than others.  Each is unique.  Tracking is how we learned some of these most basic concepts of physics.
• Understanding basic patterns of actions is a tool
• Tracking and monitoring people’s actions expands the IP’s interests without the IP having to be directly involved.  Being able to develop interests vicariously in this manner is an enormous tool
• Learning how faces can serve as a reference point and “feedback” is a tool set
• Understanding facial expressions is a tool
• Making simple associations between facial expressions and vocal tones and people’s subsequent actions is a tool: the sound of their voice and the direction it comes from
• Understanding how to follow other people’s eyes as a window into their attention is a tool: you should be able to follow another person’s eyes as a means of judging where their attention is focused
  Read more about the relationship between tracking and monitoring deficits and Autism Spectrum Disorders

Behavioral Evidence of Not Having or Using this Tool

• Action and thought are intertwined; has difficulty ignoring stimuli and inhibiting responses; impulsive; reactive; reflexive
• Has difficulty waiting because he or she does not reference the steps of actions
• Has difficulty understanding the intentions of other’s simple actions
• Has difficulty taking pleasure and interest in stimuli;
• Fails to give things much  attention or fails to follow it for more than a fleeting moment; doesn’t watch or pay attention long enough to see how things work or how they are going
• Has difficulty decoding, differentiating or recognizing patterns of events or details of the environment (noticing, recognizing, recalling); shows anxiety when steps of routines are changed
• Has difficulty understanding beginning and endings of routines and resists transitions
• Has difficulty relating separate events as a single, cohered sequence of behavior (e.g., walking to kitchen; getting cup; getting milk from refrigerator; pouring milk = “getting a drink of milk”); because he or she does not understand the pattern or reason for the task
• Has difficulty deriving meaning from monitoring events and actions and behavioral sequences (intention-reading)
• Has difficulty predicting the end results of simple and familiar behavioral sequences (predicting)
• Tunes out when teaching more than a single step; requires continuous prompting and does not seem to anticipate steps or problems
• Has difficulty using facial expressions as a reference point for where the other person’s attention is focused
• Has difficulty understanding how events affect others by watching sequences of events and how facial expressions change following events (understanding behavioral/emotional cause and effect)
• Has difficulty learning from imitating or watching what happens to others; very egocentric
• From Actions towards Impulse Control: During most of the Sensorimotor period of development (infancy through toddlerhood and into preschool), children move from a reactive and mainly action oriented approach to the environment towards behavior that is under the control of internal thoughts. The child may very well be developing inner language and conscious thought (next stage), but their behavior does not depend on or make full use of it.  A dog can have the intention of getting around a barrier for instance, and when encountering an obstacle, might run back and forth looking for openings or other ways to get around it, or looking up as if to estimate whether he can jump over it. Obviously, this level of exploration and problem solving (cognitive behavior) does not require inner language.
  • One way of looking at this shift is to look for evidence that the IP develops motor plans mostly from external sources (immature) v. internal sources (mature).  This is somewhat different from the concept of “intentional behavior.” It is a question of the source of the intention.Does the intention come from experiencing the object (reactive), almost as a knee-jerk response, or can the IP come up with thoughts and intentions that are independent of the immediate surroundings (enactive)?The IP operating mostly under the control of circumstantial experience usually does not think of or get interested in anything until he or she encounters it.  For instance, the IP tends to “follow his/her nose,” becoming momentarily attracted to objects or events that they encounter.  They are easily distracted because they do not have a strong internal plan that helps them stay focused on a goal.In contrast, the IP that operates mostly from internal sources knows what they want to do before they experience it.  Their thoughts and actions are more independent of the environment and less vulnerable to distraction.  They tend to follow their ideas or goals, rather than their nose.

…”preschool children make the transition from being “slaves to the environment” to becoming “masters of their own behavior…

…one of the accomplishments of the preschool years is children’s overcoming their impulsive, reactive behavior that is a “knee-jerk” response to the environment thus becoming capable of intentional behavior.” (Bodrova & Leong, 2005)

Tool: Goal-Directed Behavior: The IP moves from stimulus-driven behavior where his or her behavior is mainly determined by novel or salient events external to the mind, towards “goal-directed behavior” where actions and thoughts emanate from internal sources (i.e. mental representations of thought and action). Another way of saying it is that actions can now be internalized and represented in the mind as thought.

Tool: Random Trial and Error: This refers to a type of exploratory style or “exploratory means” common in the second year.  In older but developmentally young individuals, this style can be seen in their approach to objects and novel stimuli.  IPs with otherwise higher abilities in object or conceptual abilities, you may see this in their social cognitive thinking.  An example of this might be a person with Asperger’s tries random social overtures towards others, relatively uninformed by details of the social context.  When those overtures are inevitably rebuffed, what the IP does next reallyreflects the random trial and error characteristic of the period.  The IP is likely to try other social bids – also seemingly random and unconnected – perhaps even uninformed by recent negative consequences.In typical development, the child has moved on from applying mostly old behaviors to new things (e.g., puts everything in mouth; shakes and bangs everything, etc., regardless of the intended function of the object – as in Piagetian Sensorimotor substages III and IV) – to experimenting and inventing new behaviors.  For instance, the child may want to put one object inside or on top of another object (putting objects inside and on top of or under or otherwise combining or fitting objects together is often a preoccupation at this stage). The child that engages in randomtrial and error doesn’t pay much attention to size and shape features.  They may try to put objects of different sizes or shapes into another object without really examining the relative size or shape of the target.The classic example is the child with a shape sorter or inset puzzle. The child picks up a shape and tries every opening in a seemingly random manner. There is little examination of the size and shape of the object and the place for it in the sorter or puzzle.

Tool: Trial and Error with Forethought: Towards the mature end of this stage, the child looks at the problem and tries to predict the consequences of simple actions.  The child picks up a piece of an inset puzzle that has a circle, triangle and square.  The child picks up a puzzle piece, looks at it, and then looks at the insets on the puzzle board. The child looks back and forth at the board and the piece.  The child then places the piece in the directly into the correct inset with little error.  Further efforts show the same pausing and looking behaviors and the same high accuracy rate.  This is reasonable evidence that a mental process of some sort occurred in the child’s mind before she took physical action.  There is evidence of simple estimation and calculation.These and other types of thinking are involved in what we call forethought.  This refers to a type of exploratory style or “exploratory means” common later in the second year.  In older but developmentally youngindividuals, this style can be seen again mainly in their approaches to physical objects and behavioral events.Developing our abilities to use forethought in our approach to any problem, adaptation or social situation is a lifelong effort.  People with good ability to learn can achieve extraordinary levels of sophistication in specific areas of thinking.  In areas of the IP’s cognitive strength, you will also see relative strengths in their abilities to see patterns, make predictions and take different perspectives on those types of cognitive challenges.In their areas of weakness, people will have – to some degree, relative difficulty taking multiple elements into account for forethought.  This stage might then be remarkable if you see both significant gaps between one type of mental/cognitive ability andother areas of thinking, and these gaps are somehow making the behavior under assessment more likely.Older individuals may also show this in their social thinking as well, despite having other, much higher cognitive abilities. The IP with significant deficits in social thinking might show relative difficulty predicting other people’s reactions for instance.  They may take only the simplest or most observable characteristics of other’s behavior and feelings into their thinking.  In contrast, the social environment of say – of the 5^thgrade lunchroom, may require attention to many variables of verbal, non-verbal, mental and physical skills – all at the same time.  The complexity of that kind of situation may exceed the IP’s capacities for using forethought.  They may then rely on “scripts” or rote behaviors, or use behavior to be controlling or to withdraw when around others.An example here might be also seen in a person with a learning or attention disorder.  When presented with demands for thinking or attention in a deficit area are made – the IP may be more predisposed towards certain escape or avoidance behaviors.The social negative functions for this behavior can be seen in avoidance/escape behaviors. But they may due in large part to ‘functions of’ a particular processing dysfunction.For such a statement to be true here, the IP would show deficits in forethought that are directly related to the avoidance/escape behavior.  The analyst should then describe the particular area of processing which the deficit predisposes the IP to the behavior under assessment.

Behavioral Evidence of Not Having or Using this Tool

• Behavior seems to be determined by the external world and by stimuli that are before him or her; behavior seems less guided by internal ideas because he or she does not ignore irrelevant stimuli
• Takes random actions on objects or people despite prior experience; seems to have difficulty learning from experience; dependent upon random experimentation when problem solving
• Exploration seems disorganized and unsystematic
• Exploration seems to lack a specific goal
• Actions of pursuit or exploration are limited to single or few steps; instead of continuous or dynamic responding to objects, actions on objects tend to be repetitive or stereotyped

The subsequent stages of this taxonomy involve higher organization of thought, as described by the Greenspans and to what most refer to as cognitive “executive functions.” Thought and action are no longer intertwined.  The person can rehearse actions and anticipate consequences internally.

…children can now deliberately remember specific features, ignoring those that are not relevant regardless of how bright and enticing they are. Instead of immediately grabbing a toy that another child has, the intentional child can think about strategies to solve this social problem or ways to keep anger under control…

Intentional behavior is developed through the use of self-regulatory private speech and through participation in make-believe play, both of which pave the way for the development of higher mental functions (Bodrova & Leong, 2005)

Tool: Internal Rehearsal: “Internal rehearsal is another type of thinking that we perfect over a lifetime.  It is measured in terms of the level of complexity, abstraction and integration of thinking required by the environment and the context, and the level and extent of skill development in the IP.

Tool: Private Speech: “Inner language” was important to both Vygotsky and Piaget. Piaget maintained that ‘thought’ was not possible without it (we now know better).  Both stressed the mental tool of inner language.  Inner speech not only facilitates thought, it tends to reflect speech heard from the external world of the child’s culture (adult language speakers in the environment).  Private speech often if not usually accompanies inner visualization of what we see, think about and remember (below).Behavioral psychology puts inner language among other “private [mental] events” that we know occur but cannot measure. This is an inarguable point. In the case of internal speech (cognitive linguistic processing), we can only go by behaviors we can actually observe and measure in the IP’s behavioral repertoire.Overt behavioral evidence of private speech can be observed whenever that speech comes to the surface, such as when the IP talks to herself, thinks aloud, communicates her thinking in words or gestures or patterns of behavior, etc.

Tool: Self-Instructional Speech: The ability to talk one’s self through their own thinking steps is a tool that is particularly helpful with new or complex aspects of a task or demand.

Look for overt behavioral evidence of the IP’s use of self-directed speech such as thinking out loud; talking to herself; pausing for a moment while focused on the object or event somehow; other ways that reveal that the IP is thinking in words…

Self-report

We can simply ask the IP to report their thinking if he or she is capable of that.  Self-reports and answers given in response to questions provide a phenomenological account of the IP’s thinking.  There are so many emotional and psychological filters involved in the IP’s thinking that phenomenological accounts can only serve in comparison to more reliable evidence. While phenomenological accounts can be very useful, especially in willing and cooperative and aware persons – they are notoriously unreliable. Whatever the IP reports, it is only the overtly observable and measurable behaviors that can be analyzed.

Nevertheless, phenomenological accounts can provide useful information that either supports or contradicts the Analyst’s hypotheses about the IP’s inner speech.

Tool: Sharing Thinking: The ability to purposefully share one’s thinking with others is with words is a tool: This tool requires accessing a memory or internal representation of what happened, and then putting into communication symbols of some sort.  It involves translating the internal world into symbols that others can make sense of.  Overt speech may be a poor indicator of private speech.  Overt speech may be limited in cases of speech-motor impairment and expressive language delays (e.g., dysarthria; dyspraxia), and not reflective of the true nature and complexity of the IP’s thinking.What matters here is how the IP uses any manner of communication to communicate and share one’s thinking.  One has to have access to one’s own thinking, which is retrieved and managed in mental symbols (words; images). Then one has to convey thinking in forms that are understood by others.Therefore, the IP’s responses to the world reflect not only their own understanding of their private thoughts, but a capacity to know what signs and symbols mean to others. Reciprocal interaction with the others requires encoding one’s thoughts into a symbol system we know communication partners understand

The ways in which the IP encodes their ideas into outwardly expressed communicative signs, symbols and words are overt and therefore observable, measurable and possibly remarkable.

Tool: Visualization: As primates, visual thinking predominates. Our ability to “visualize” stimuli is as important, if not a more important form of thinking as inner speech.  Visual forms of thinking and memory shuffle around “visual experience and memory clips” that enable us to remember and to think beyond immediate circumstances and the ‘here-and-now.’We use memory to project ourselves in time into the past (remembering) or future (imagining, anticipating) by visualizing.  When we think about something, we might “re-run” short, fragmented scenes.  These scenes are not static photographs – they move.They are experienced as action clips– always including some sort of movement or action. The work of thinking is done in areas of the brain that handle emotion and motor action.  In early development, there are few inhibitory mechanisms in place for thinking about, but not acting on, intentions.  Intention and action are coupled – they are two sides of the same coin. Emotions and actions are also highly coupled in early development.Thought represents the ability to focus on and modify actions without actually acting out the steps physically. Thought is now decoupled from action, but thought is about action.

You are not “thinking in pictures” or in terms of static scenes.  There is always movement and action in thought.  This is because motor parts of the brain are very influential in the anticipation of what happens.  Visual motor reactions were necessary for survival long before language ever developed. Verbal thinking emerged very late in evolution and was ‘tacked on’ to existing equipment for visual thinking.  Infants experience most of their reality to being a part of or watching actions.  Words don’t really come on line until after many thousands of visual experiences.

Visualizing becomes an automatic mechanism experiencing the world in the present starting at birth.  It is first used to notice and differentiate among visual stimuli.  Later on, it becomes a medium of memory.  We may find overt evidence of this in anticipatory behaviors we might observe in the IP.  This can be signs of visual imagery serving as a proxy for what one expects to happen.

• Anticipation is a tool that requires being able to recall memories, or to recognize patterns; we have to be able to “see ahead” to some extent even to move through the environment.
• Being ‘flexible’ is a tool that requires us to re-think: to re-sequence the steps and actions and anticipations involved, etc.; to re-imagine or re-sequence in order to accommodate changes and to anticipate ; to trust one’s own abilities to the point that he or she is not overwhelmed by normal demands for flexible responding
• Being able to encode visual scenes as “movement clips” is a tool that allows us to remember, anticipate and imagine, as described above.  Visual encoding is how you remember what you saw. The eyes take in light information in the form of light waves.  The brain forms an interpretation or representationof them as a visual perception.  The perception can be associated with other mental representations to form concepts and ideas.There is an inevitable association between visualization and action.  That is because the act of noticing and focusing visual attention on something is an action in and of itself.

This bias towards thinking in terms of visualized actions is consistent with the fact that in phylogeny, verbal thinking emerged only in one species and very late in evolutionary time.  Further, verbal thinking emerges later than visual thinking in typical child development.

Visual thinking is an important tool for understanding what others say. When we hear language we “imagine’ what they’re saying by converting what they say into our own personal imagery.  This allows us to “see what others are saying.”  It facilitates our memories of what people say or what we read.  Deficits in visual thinking are highly correlated to difficulties with listening and reading comprehension.

We use visual understanding to understand how non-verbal signals such as body language, posture, speed or direction of movement, etc. influence or change the meaning of spoken words.  This is the essence of inference.  We are able to use visual information from nonverbal signals long before we engage in linguistically-based inferential thinking.  By the end of the first year, we are remarkably adept at recognizing patterns of events around us as signals and signs that we use to anticipate what will happen next.  These are the beginnings of understanding intentions.

The mechanisms we use to do understand intentions and there anticipate and predict actions, are largely visual and motor-based.  We watch other’s behaviors and quickly match what we see in their current or past movements with patterns we’ve experienced (seen).

We also try to “envision” what others say in order to comprehend the content. The extent in which each of us can visualize what others say is intimately related to listening and reading comprehension.  Complex visual thinking is required to go beyond simple visualizing to tying ideas and cause and effect together.  Experience-sharing past toddlerhood is increasingly based on shared symbols (language) and shared visions (cultural similarities and similarities of experience).

Deep visualization is involved in higher forms of thinking that visualize one’s own and other’s thinking (thinking about thinking).  It is also a necessary component of perspective-taking and empathy.  Behavior Analysts may see profiles of relatively high levels of intelligence in other cognitive areas, but difficulties using visual thinking for understanding the thinking, intentions and feelings of others.

• Some individuals may be able to “envision” a limited amount of what happens. They may be slow to form visual representations of reality or language in their minds and get lost in fast or complex verbal interaction.
• These individuals may also show deficits in thinking of alternatives choices and consequences, because that is a matter of visualizing how patterns of action end up.
• Converting visual representations in one’s own mind into communicative signals is an important visual thinking tool.  It is how we translate the mental images in our heads into symbols and words in order to share them with others. The way the IP communicates ideas to others can be an important insight into their thinking.The way the IP communicates ideas to others also comes up as a concern when the behavior under assessment has a social relating component to it.

From Words to Images and Images to Words
I share with you that I went to my grocery store and picked up a carton of eggs; some potato chips; soda and some salad dressing…

• (Vision to Attention) The idea first emerged as a visual representation of the memory in my head
• I chose to share it with you and formed an intention to communicate.
• This intention may “load up visuals” of other experiences I’ve had sharing other things with you.  That reference point influences how I might choose to express myself to you.
• From these developments, I always have anticipations of your responses.
• (Vision to Communication and/or Language) I have to convert my internal visual representation into a medium that my sharing partners understand. That can include visual communication through body language and gestures (that I anticipate that you can understand).
  • I convert my internal visual representation into some form of visual symbol we both can interpret the same way.  I use language to “describe the scenes” in words and in a manner I anticipate (visualize) you will find meaningful.
  • Throughout the course of reciprocal actions with others, including communication, one looks for visual feedback.  Back and forth sharing of information depends on partners’ capacities for interpreting visual feedback.
  • (Language to Visual Symbols) Partner’s respond to my language by forming visual representations of what I’m saying.
  • (Vision to Communication and/or Language) Partners respond with language of their own.
    • Their verbal expressions were preceded by the visual representations too
    • What they say is the verbal/linguistic symbolization of their thought
    • They choose language based on their anticipations or their understanding of our understanding

Behavioral Evidence of Not Having or Using this Tool

• Acting before thinking; difficulty thinking out steps without action
• Limitations on Stepwise Thinking
• Difficulties with Following Steps and Directions
• Behavioral Inflexibility: Poor toleration for change or uncertainty
• Difficulties considering multiple elements involved in complex situations (e.g., working in a group)
• Limitations on Divergent Thinking (imagining; creating; finding alternatives; adapting)
• Difficulties with Sharing Experience
• Difficulties “seeing what others are saying” (visualizing for comprehension)
• Difficulties “seeing what others mean”
• Difficulties remembering and telling stories (visualizing for expression)
• Difficulties with Theory of Mind (i.e. knowing what others know or need to know)

Difficulties “seeing what the other needs to know” (painting a picture for the listener; providing coherent-enough detail and sequence

• When people have difficulty with visual thinking, certain overt behavioral patterns or traits may be evidence of deficits in visual thinking:

…losing one’s place; rigidly over-focusing; rigidity and resistance to shifting attention (to avoid losing one’s place)
…problems maintaining attention and/or filtering distractions
…problems evident in transitions from one activity to another or from one idea to another
…problems evident in the IP’s approach to novelty, uncertainty and challenge
…problems with remembering the sequences of events
…problems explaining stories or directions in sequence or in a coherent, organized manner

Tool: Signification: Consistent with ABA, we’ve been saying that while we acknowledge that covert mental behaviors exist, (e.g., perception and meaning-making; forming intentions; thinking, etc.), we cannot measure them directly.We do not respond to reality.  We respond to our perception of reality.

In this section, we are interested in how the IP represents reality in his or her mind – to the extent possible. This helps us understand and identify processing issues that may influence behavior. The evidence of the perception an individual ‘takes-away’ from what happens can only come from their overt actions.  For instance, we can readily observe the kinds of symbols that an individual responds to.

Knowledge of the processing characteristics in the IP helps us avoid haphazard approaches towards finding the right modifications to make in teaching or the environment, and it helps us select replacement behaviors to teach.  Once we form a hypothesis about processing deficits, we can provide compensatory or remedial measures more accurately, and we can do so with less wasted time and effort.  Provision of compensatory modifications or remedial teaching procedures will also help to fine-tune hypotheses of the IP’s processing.

Note: In the sections on communication, we will use similar terms to analyze how the IP puts ideas into symbols for the purposes of communicative expression.  That is a higher bar than simple representation in the mind, because it takes motor coordination to produce and use symbols that others can see.

Index, Symbol, Icon

For insights here, we look to the emerging field of “Cognitive Semiotics” for tools to help us understand how the IP represents reality in his or her mind.  Cognitive Semiotics’ aim is to provide insights into “human signification” and its manifestation in cultural practices (“What is Cognitive Semiotics?” Article posted in the on-line Journal of Cognitive Semiotics, The Multidisciplinary Study on Meaning and Mind website; accessed 9/17/12).

According to the Journal of Cognitive Semiotics editors, long before Piaget and Bruner created their own taxonomies of meaning-making, Charles Sanders Pierce created the symbol/index/icon triad.  This tool of analysis is at the core of semiotics, a discipline the study of signs and their meanings.  The symbol/index/icon hierarchy is now used throughout many disciplines.

Index: Indexes/indices “indicate.”  They are directly influenced by the objects they represent.  Meaning comes from the index’s direct resemblance to reality.  This is the simplest form of sign, usually understandable to infants by about a year of age.

Indices will always point to, reference, or suggest something else. So if the IP can recognize patterns of actions or the presence of certain objects as indicating something else, he or she is responding to an index.  For instance, a child can tell that bath time is approaching when he sees his mother running the bath water; a Student may recognize that it is almost time to go home when she sees her Teacher handing out back packs; having your back turned is a sign that the IP recognizes to know that you cannot see him…

A piece of an object can also represent the rest of the object (e.g. the brush handle is visible but the brush is not – the child still recognizes it as the brush).  Object representations can function as indicators and can be more effective signals than words for some persons (see article on Object Communication).

Gestures such as pointing, proper names and the word “this” (accompanied by a point) are also forms of indices. Therefore, if the IP responds both consistently and differentially to object and action indices, you have evidence that the IP understands these types of indices. (The IP may not be at the level where they can use indices expressively or with evidence of mastery, and if this is the case, it is remarkable in the Communication Assessment section).

Symbol: A symbol is marked by its resemblance to the object, but it is distinct from the object.  The following aspects of communication are considered “symbolic:”

Symbol Levels
Imitation	The IP   understands specific gestures such as turning the wrist to indicate “key” or  wringing hands together to indicate washing hands.  Can understand by imitating an animal what   animal it is.
Physical Models	The IP   recognizes figures (dolls, toy trucks, etc. – 3-D objects) or drawings as   representative of the real thing.
Pictures	Understanding   of 2-D stimuli (pictures and drawings as representations) comes somewhat   later than understanding of 3D representations.
Make-Believe	In-between   realistic looking 3-D objects and “signs” are object representations that   have little resemblance to the real object, but the IP understands represents   something specific (e.g. a pencil represents a brush; a broomstick represents   a horse to ride on, etc.).

Sign: Signs have no resemblance at all to the objects or events they depict.  The only way to use “signs” to communicate is to have an agreement among a language community that defines the representation.  For instance, the collection of sounds that make up the word “cup” means a short drinking vessel to members of the English language speaking community.  This same collection of sounds would not have the same meaning in another language community.

• Behavioral Evidence of Not Having or Using this Tool
• Has difficulty understanding what nonverbal, gestural and extraverbal (tone of voice; inflection; volume) signals add or change about the spoken words; misses nuance; literal; doesn’t understand sarcasm
• Limited use of gestures and emotional expression to accompany expressive language
• Dearth of imaginative play or creativity
• Difficulty understanding allegory, fables, figurative expressions and other metaphors of meaning

Overt Rehearsal

You can learn a lot about someone’s thinking just by watching their behavior – while they are thinking and problem-solving. At this stage, the IP can form goals and use forethought to think of and execute steps towards that goal.Here we look at another tool for learning – overt, behavioral practice.  We’ve already looked at two forms of learning tools that are similar, but reveal a stark difference in thinking: the difference between random trial and error and trial and error with forethought. By definition, overt rehearsal requires forethought.  We are not talking about random, accidental learning. Overt rehearsal is an active tool for perfecting behavior, discovery, and problem-solving.

Overt rehearsal requires the mind to observe what happens in the world with mental representations; to store those representations (at least in temporary forms of memory) long enough to be able to emulate it; and to coordinate the behavior into physical action.

A person’s level of practice can vary greatly within the stage.  At the earliest and most basic levels, we can see forms of play where the child enacts roles he or she might do personally, or that has seen others do.

Beginning Representation

When we see a baby hold a toy phone to her ear, we see the earliest fragments of representational play.  The child uses a combination of her own body and objects that she has experience with – either by doing the behavior herself (e.g., eating or drinking), or that she sees others do (e.g., hold a phone to her ear). At the early levels of this stage, such enactment consists of a single step (e.g., hold phone to ear; drinks from empty cup; feeds baby; emulates a one-step action).

Representational play emerges in typical development in the second year. It progresses into full-blown dramatic play where children enact behaviors associated with roles (e.g., emulates a Mother; Teacher; Police Officer; Spiderman).  It is from this form of play that the seeds for abstract thinking are sown.

In typical development, dramatic play is followed by the types of practice required of school-aged children, which includes learning from books; practice with worksheets and, activities. The IP shows understandings of what practice is and what it is for. Vygotskian Guided Participation Teaching incorporates guided practice as a primary strategy.

For most of us – we continue to use such behaviors to form imitative gestures (see table above, Imitation), and to engage in purposeful practice. “Purposeful practice” requires a certain level of emotional and cognitive sophistication: understanding the need to perfect a behavior; the role practice plays as a means to get there; and, the motivation to persist in the face of inevitable mistakes and failures.

Types of Practicing and Imitation

Below, we describe types of representational behavior: practicing with objects and practicing roles and reality. Practice with objects emerges first, as such practice doesn’t really require recreating a social context.  Dramatic play, replete with enactment of roles, role characteristics, role functions and role-related behaviors, emerges later. Over the course of a lifespan, a person’s mastery of social imitation may become superseded by their familiarity and practice with objects.  For instance, a physicist with Asperger’s Syndrome may construct extremely complex and abstract models of the universe or the behavior of atoms – yet still show poor understanding of social behavior.

• Practicing with Objects: This strand of development starts with very simple copying behaviors using household objects in the way the IP is familiar, all the way to sophisticated forms that require an understanding of an ideal to practice towards, as well as the ability to reflect on one’s own imperfections, errors and mastery. As mentioned, this form of practice usually emerges before the use of symbols (see above), but can continue to develop in sophistication and complexity throughout the lifespan.Andrew Meltzoff’s taxonomy of imitative learning is useful here (see more detailed description above).  Meltzoff’s hierarchy moves from simple copying of the topography of other people’s behaviors towards an intrinsic understanding of the goals and perspectives of the other person and their behavior (i.e., that person is like me; therefore, that person must have thoughts or intentions like me).
• Practicing Roles and Reality: This form of play requires social interaction and the reciprocal communication of ideas.  In order to do this, simple indices have limited value and cannot define a ‘play role.’  This type of play requires symbolic thinking and communicating.Quoting the work of Daniel Elkonin, a disciple of Vygotsky, Bodrova and Leong (Bodrova & Leong, 2005) describe Elkonin’s analysis of dramatic play.

“Elkonin describes mature (he used terms such as elaborated and developed) play as focusing not on the objects but rather on human interactions that occur as people interact with objects. Thus, mature play does not require realistic toys and props as children learn to use substitute objects that are different in appearance but that can perform the same function as the object-prototype. As play continues to advance, these objects-substitutes become eventually unnecessary as most of the substitution takes place in child’s speech with no objects present. Another feature of mature play, according to Elkonin, is a shift from extended acting out preceded by rudimentary planning to extended planning followed by rudimentary acting out.”

Elkonin points out that dramatic play relies on some level of mastery of symbolic play:

• Symbolic Play: “…children do not act out the exact behaviors of the role they are acting out but rather they act out a synopsis of those actions. They, in fact, generate a model of reality or construct their own version—something that requires symbolic generalization.…Children do not act out everything they have seen “mommy” or “daddy” do at home, but distill the essence of mommy-hood and daddy-hood.  In both instances, the use of symbols is first supported by toys and props and is later communicated to play partners by the means of words and gestures.”
• Interactions with Play Partners: “…to agree on the details of a play scenario or on the specific use of play props children need to spend some time prior to play in discussing their future actions—essentially planning their play. This play planning is the precursor to reflective thinking, another aspect of self-regulatory behavior.”
• The Rules that Govern the Play: “Finally, in mature play of older preschoolers the roles children play are mostly the roles of adults (doctors, drivers, chefs, etc.) engaged in socially desirable behaviors. By imitating these behaviors in play, children learn to adjust their actions to conform to the norms associated with the behaviors of these role models, therefore practicing the planning, self-monitoring, and reflection essential for intentional behavior…”He remarks that in order to do well in school, a child must develop an understanding of his or her role as “learner,” as well as to understand the roles of Teachers, peers, boys, girls, and other roles based on cultural expectations.

“The transition from preschool to school means major changes in the social situations that the child participates in—a change in the nature of the interactions involved in schooling and in the expectations associated with the role of ‘student.’  …There must also be a change in the child’s awareness of these expectations concomitant with changes in the child’s ability to meet them. To adjust to the social situation of development of school, the child must be aware of the new expectations as well as possess the capacities to meet these expectations.”

Behavioral Evidence of Not Having or Using this Tool

• Difficulty with emulating motor actions (getting the motions right; getting all of the steps or part of a movement)
• Difficulty with emulating motor actions (misses stylistic elements [fast/slow enough; gentle/forceful enough; careful/quick enough], etc.)
• Difficulty understanding the intentions of others by observing their actions
• Lack of pretend; lack of pretend play skills
• Can think of only one way to do things; has difficulty reharsing different scenarios mentally
• Difficulties predicting what will happen next
• Difficulties with inferential thinking

Tools of Executive Thinking and Motor Planning
Can the IP think about or do anything else while focused on an activity or thought? 

Imagine that you are preparing dinner. You have the ‘goals’ of making dinner: make a salad; prepare the chicken entree and other courses; pour the beverages; set the table, etc. ‘Preparing dinner’ is a motor plan. It has a sequence and steps that have to be enacted in a certain order. Typical of life, you have to deal with certain realities that were not part of your original motor plan and you’ll have to adapt – without losing sight of your original goal – to make dinner.

You have to deal with practical realities…

…you might not have any salad dressing, so you have to improvise and make some of your own; you planned to make the chicken one way, but you looked at the calories on one of the boxes and decided that your original plan for the chicken will have to change – so you consult a recipe book and search for another way to make chicken. This involves also rethinking the chicken as well as your inventory of supplies.

You also have to deal with distractions…

…the phone rings. It’s your doctor’s office.  They want to re-schedule your appointment. You realize that you cannot take time at the moment because you are too busy.  You estimate how long it will take you to get the chicken is in the oven, which you figure would allow you the time to call the doctor’s office back. You finish preparing the chicken to go in the oven and then wash your hands.  You consult your calendar and call the doctor back. After several back-and-forth exchanges with the doctor’s office, you agree on a time.  You write it down.  You call your job to let them know you won’t be in.

After all of those exigencies and interruptions (which really represent spontaneous goals and motor plans inserted into your original one), you still somehow can return to your original motor plan of making dinner.

As you can see from the example above, in order to keep the ‘making dinner plan’ on-line, you have to juggle. You have to rethink, re-imagine, and re-sequence throughout. Internally, your attention must shift back and forth between goals, and you have to retain steps of each motor plan somewhere while you work on the one in front of you at the moment.

The above is a description of a pretty high level of executive function. Hopefully, you can also imagine the range of this capacity in the populations you analyze and teach.  Once again, you look at the IP’s capacities and deficits in relation to the demands of the environment.

Tool: Sequencing: We discussed ‘sequencing’ above as part of Greenspan’s taxonomy.  In this subsection, we look more closely at the tools of sequencing the IP has or has yet to develop.

Tool: Breaking the Whole into Steps and Sequences: The chicken dinner didn’t just end up on the plate. The chicken had to be thought of, bought, prepared and cooked. You could not eat a chicken you didn’t get or cook.  Therefore, in order to accomplish the goal of preparing a chicken dinner, you have to put steps in order.  And, as the example shows, life usually demands reworking of the steps.Sometimes, the skill is in being able to follow a series of already established steps. This is a tool in and of itself.

Other situations may require the IP to think of the steps. Their capacity to do so will have to do with varying levels of other underlying skills (e.g., the ability to handle knives; the ability to read directions from a cookbook, etc.).  Assuming that an individual has the underlying skills, we then look at how he or she looks at a problem and then approach it.  We look for differences varying from haphazard and poorly sequenced motor plans, to problem-solving that involves breaking the task down into its component parts.

Tool: Ordering: It is difficult to think of sequences and component steps without thinking about how the IP puts them into a logical, workable order. The following is an example given by the Greenspans, describing a child that might otherwise be intelligent, but has difficulty breaking the whole of the task down into actionable steps and then sequencing them…

“Mom asks her son, Jonah, to make a peanut butter and jelly sandwich for her. An easy task, right? Well, what does he have to do? He has to go to the refrigerator, get out the peanut butter, get out the jelly, put the jars on the table, get the bread from the box, put it on the table, get the bread from the box, put it on the table, open the cutlery drawer, get a knife, put it with the jars and bread, open the jars, pick up the knife, spread jelly on one piece of bread and peanut butter on the other, put the two pieces together, put the sandwich on the plate, and bring it to her.  Sixteen steps. None of them individually seems onerous, but for a child with motor planning and sequencing trouble, all together they are Mt. Everest.  Jonah is more likely to end up sitting at the table and licking peanut butter off of his fingers than he is to spread it on bread to make a sandwich.” (Greenspan S. a., 2010)

Some may recognize the above as a task analysis. That is exactly what it is, except that it isn’t written down. In this section, you can look at the IP’s individual to “task analyze” – in other words, to figure out the parts and the order of steps.  You also look at capacity for doing more than one sequence at a time.

Tool: Understanding that Learning is a Ladder (Mapping Goals on the Way to Other Goals): This has to do with the IP’s mental capacities for understanding goals that can only be accomplished outside of the here and now.  It has to do with the realization that there are intermediary goals to be accomplished before getting to an ultimate goal.Many of us have experience explaining to young children or individuals with special needs that “First we have to do X and then we can do Y.”  Here, we look at the IP’s capacities to “map out” the succession of accomplishments needed to obtain a given goal on his or her own, as well as their capacity to understand maps given by others (such as your course syllabus).

Mapping goals may also represent a higher, if not formal operational level of function in this respect.  The IP demonstrates understanding that practice will be necessary.  The IP knows that to learn a complex skill, there will be any number of steps and practice involved.

Here, we are concerned mainly about the knowledge that there are steps involved and that success is a matter of practice.  The IP does not expect to be able to do something complex without preparation and practice.  There is evidence that the IP can think in the long term and map out steps towards a long term goal (e.g., writing a paper; becoming a doctor). That has to be understood with some independence in the IP.  Following others recommendations or demands to practice is more of an emotional skill.

This particular analysis of the IP’s cognitive ability should occur when the environment seems to demand that the IP perform steps seemingly unrelated to their goal (e.g., I want to be a pilot, but I don’t want to do my math homework; I plan on being a musician – I just never practice my instrument; I want to eat, but will only eat prepared foods that don’t require me to prepare anything).  The IP cannot form a map of accomplishments and steps towards a longer term goal.  By “longer term,” we mean enacting steps that will not result in obtaining the goal right away. The steps occurring now may not resemble those that are part of the ultimate goal.

Behavioral Evidence of Not Having or Using this Tool

• Deals mainly with immediate goals; has difficulty deferring gratification
• Poor frustration tolerance; gives up or gets angry if things prove difficult; lacks persistence, resilience
• Has trouble with stepwise behavior and problem-solving; gets lost in the steps;
• Loses trains of thought and ends up pursuing distractions and forgetting what he or she was doing
• Doesn’t understand why he or she needs help; doesn’t understand why people need different things; claims everything is unfair

Tool: Retention and Imitation: The mind has not only the ability to rehearse actions without physically acting them out, it uses the same powers of retention to perform physical rehearsal in imitation.  Therefore, the mind must have some capacity to represent and retain models of the outside world long enough.But the capacity of the individual to perform imitations varies among individuals, even when they can already decipher other’s intentions and act accordingly. Here, we are talking about the ability to think about more than one thing at once and/or, the ability to keep a motor plan ‘on-line’ while doing other, non-related things.

Tool: Retention and Cognitive Set-Shifting: A “cognitive set” is the collection of mental representations involved in an idea.  Thinking about one thing and then thinking about something different requires the mind to shift everything from attention, to memory to the forming of a motor plan for doing the next thing.  The processing actions involved in the attention, memory and motor plan for one activity or thought process constitutes a “cognitive set,” and the thinking about the next thought, action or activity requires a shift from that set to the next one and the forming of a motor plan connected to it.For instance, if they are involved in an activity, and you ask the person to think about something else (e.g., the next activity – to prepare for a transition or change; to incorporate different ideas that others suggest; to “notice, take in and process” what others are saying and doing while they are busy with their own actions.

“Retention” (for our purposes here) is remembering what you were originally doing while thinking about other things (past or future).  Can you see at this point how this might affect a person’s willingness to transition from one thought to another or from one demand or activity to another?  Let me explain a little further…

• The “X and Y” Problem:” I have taken to calling this the X/Y problem.  This is where ‘X’ represents the IP’s own motor plan: the focus of his or her own thoughts or activities, and where ‘Y’ represents competing stimuli.  For instance, if a child is playing with his blocks and you ask him to go to the potty, he cannot think about going to the potty while he is playing with his blocks, and will respond with a reflexive “No.”  This is not just a case where the person does not want to stop what they are doing.  The problem is that the IP cannot give the request any real consideration due to limited processing capabilities.  The IP has difficulty thinking about what you are saying or asking while he or she is involved in thinking or action (X).
• Imagining and Episodic Memory: This is related to the X/Y problem. The IP might have difficulty retaining more than one idea in mind at a time.  When the IP is ‘doing X’ or ‘thinking about X,’ he or she seem not to have room in their minds for “picturing” or imagining (root: imagine, image) what you are saying.  Picturing and imagining is how we remember and how we project memory into the future (what David Ingvar termed, “memories of the future”).  Projecting memory of prior experiences allows us to anticipate similar situations in the future.

For instance, a child may be doing something that is pleasant but perhaps not that exciting, and you can say, “Let’s go for ice cream!” and you still get the reflexive “No.” A lot of the time, if the person is given a moment or two to process, they can do the shifting of cognitive set.

Tool: Context: Context is a very broad issue that can include any number of elements and any number of interpretations. Contexts are personal andshared. People can find different aspects of the same context meaningful. Analyzing every possible element of a context is impossible.Usually, there a few key reference points that are salient, which is how we can share the meaning of the same context.  People can focus on common sources of information and can “stay on the same page.”  For instance, it is easy to agree on clock time, as the clock is a singular source of information for people sharing a context.  If I say it is 4:30 pm, I can point to the clock, and if we all assume the clock is right, we have no trouble agreeing on it.  The same thing would be true whenever we refer to any source of information that is tangible or at least concrete: a label for something; a term; a place or location, etc.

But what about simple concepts such as “soon,” “there,” “it,” “you,” “a lot” and many others that require a certain point of view in order to interpret them?

These statements could very well be true at the same time…

Dinner will be ready soon.
My birthday will be here soon.
I’m going to pay you back soon.

Context would tell us a lot by what speaker meant when he said by ‘dinner’ and ‘my birthday’ coming soon.  This is a phenomenon in language – and also in thought, where the meaning of something is dependent on the context in which it is uttered.  It is called deixis.

But we all know that terms such as these can cause confusion and disagreement in very typical, normal situations among intelligent people.  Dinner being an hour from now may not be “soon” for me, and Thanksgiving, being a few months away might be too “soon” for you.

Stanley Greenspan pointed out that emotion provides a good deal of the context – not just one’s position in time or space. Paraphrasing, “a lot” is when there is more than you expected, and ‘a little’ is when there is less than you expected.

But it can be difficult to share such meanings. In such cases, we often ask what others mean by what they’re saying. They would have to provide more information. So if I said that I would pay you back “soon,” that might not satisfy.  You might ask me what I meant by that, in which case I would need to give you a date or time – something that is concrete.

Well, if these terms can be confusing to anyone, they can be particular problematic when we assume the IP understands them. In fact, misunderstandings surrounding vague or context-bound terms are the source of many problem behaviors.

Think of what might happen to your behavior after you ask me 4 or 5 times when I’m going to pay you back, and I reply, “Soon!” each time. Each time I reply with information that you cannot use, you might become more anxious. Finally, the anxiety might get the best of you, and you might lapse into inappropriate behavior.  By the way, I wasn’t really referring to you. I was referring to him. Who? Him.

Behavioral Evidence of Not Having or Using this Tool

• Has difficulties understanding context and how multiple variables interact
• Very concrete, literal, black and white; difficulty understanding shades of gray
• Difficulty understanding things in more than one way or from other perspectives
• Difficulty thinking about anything other than one’s current actions
• Blocks out the environment when busy
• Difficulty dealing with more than one thing going on at a time
• Difficulty assessing situations and finding patterns; enters with own agenda and has difficulty incorporating and adapting to changing information into ideas and plans

Tool: Visual Spatial Elements/Patterns: We get a good deal of information from visual spatial patterns.  We can recognize that people are playing baseball or kickball simple by where they are standing and where they are facing on a field.  When we go to the movie theater and see people standing in a line, we might want to ask someone, “Is this the line for Batman?”Using visual spatial configurations to gather social meaning and implied expectations for behavior is a social cognitive tool. There are too many ways and possibilities in which this can lead to behaviors underassessment. The table below gives examples of how the lack of this tool can be a setting condition for behavior.

Spatial Configuration	Implication	What can happen when you don’t get it
A group of   people sit facing one way; they are all seated in desks or tables in columns   and rows; one person is facing the group and standing.	Classroom?	You walk right through the middle of the group; you make   noise as if you are the only person in the room
People are   standing in a line	Waiting?	You walk right up to the front
People are   gathered around and looking at a common object	Conversation?   Project?	You might start talking or ask for something and forget to   ask to be excused first
People are   all looking in one direction	Common focus   of attention?	You miss something that could be very relevant
The Teacher   walks around the classroom, going down the columns of desks	Help is   coming?	You expect the Teacher’s attention out of turn
A person   walks in with a cup and a plate of food and places it on the table in front   of it	The food and   the plate belong to her	You take a drink from the cup or take food off of her   plate: you are accused of stealing food

Individuals on the Autism Spectrum are prone to miss visual/spatial reference points and therefore to make some the mistakes listed in the column on the right.  The same is true for any person that has not learned the visual/spatial reference points needed and therefore misevaluates the [visual/spatial] context.  Very young children often make these mistakes. Individuals that tend to go too fast (e.g., ADHD) or that are for some reason are very self-absorbed are also prone to making such mistakes.

Tool: Patterns Involving Temporal Concepts: Just as visual spatial elements can define the behavioral expectations of an environment as well as the IP, so can patterns of time and duration. The IP’s understandings of time and duration can have a lot to do with behavioral issues that have to do with waiting (“How long will I have to wait for…?” “How long will this take?”), transitions (“How long do I have left? “What can I get done before I have to change activities?”) and attention-seeking (“How long will it be before it is my turn?”).It is easy to understand how miscommunication can occur when we try to speak in terms of time to individuals that do not yet have concepts of clock time or denominations of time (e.g., minutes, hours; this afternoon; tomorrow; “Wednesday;” Feb. 15^th, etc.).

How fruitless is it when you tell your two-year-old that you will get off the phone “in 5 minutes.”?

How fruitless is it when a Teacher warns her Special Education classroom, where no Student tells time or knows what “minutes” are, that, “We will be going inside in 5 minutes.”?

This is not really different from any other source of communication where the listener does not understand the reference points that the speaker uses. It can be illustrative to look at some examples of temporal reference points that answer our own questions about waiting, transitions and attention.

The Doctor’s Office

When you go to the doctor’s office, you may use the following reference points to make a judgment about how long you have to wait…

You go up to the Receptionist’s window and put your name on the list.  You look at the names ahead of you on the list.
You ask the Receptionist, “About how long will it be?” She says, “I can’t really say.  It varies.”
You sit down.  You watch how long it seems to take for the Nurse to call people from the waiting room.
From these reference points, you estimate how long it will be (you reference your own concepts and preferences for waiting time). You reference your estimate to make a judgment about how you will spend your time waiting.
You make a “waiting plan.” If you anticipate that it will be a very brief waiting time, you might just sit there and wait. If it seems as if it will be a long time, you might make other choices (e.g., read; make calls, etc.).

The Restaurant

The restaurant isn’t much different; except that you may get to pass the time with others. Or, you may be forced to pass that time with young children, in which case it can be challenging!

You go to the restaurant with your two very young children – neither of whom can tell time or know what “minutes” or “hours” are, nor do they have a very long lifetime of experiences with waiting at restaurants.  That fact should be a reference point for the parent!
You put your name on the waiting list and ask how long it might be. You get the same non-response.
You look at how many people are waiting in line. You look around at the full and empty tables.
You look to see how long it takes for them to call each name.
You make an estimate.
You take out your duffle of toys and help your children, because they’ll need your help to come up with the right waiting plan.

The Student

The Student is waiting for attention from the Teacher. The class is engaged in Guided Seatwork, where the Teacher circulates.  The Teacher may do this in a sort of fixed pattern, moving from desk to desk as she goes up and down each column of desks and across the rows.  In another classroom, the Teacher may do this by visiting each table he thinks needs help, but in no particular path.

The Student looks at the pattern of the Teacher’s movement and deduces a pattern from watching him.
The Student can develop a judgment of how long it seems to take for the Teacher to move from one table or desk to another.
The Student references rules on eliciting Teacher attention (e.g., raising hand)
The Student finds ways to occupy herself while waiting
The Student makes social references as to whether or not the ways she finds to occupy herself preserve or disrupt existing patterns of Teacher attention and Student productivity

While we will address intervention in later chapters, it is important to point out her that “pre-time” children tell “time” more by sequence than duration.  They know when things are “all done.” “First bath – then TV.” “No more ‘replays.’ Once you get to your level, it’s time to turn the game off.” They know when things are full or empty. “When all the water is gone, it’s time to get out of the tub.” “When all of the marbles are in the jar, we will be at Disneyland.”

A friend of mine’s husband had a job with a multinational corporation. More often than she ever wanted to, she would have to travel – sometimes 20 hours or so on an airplane, with two children – one of whom had Autism. I asked her how she did it. “I gave them a present every half-hour. Each one was an activity.”

Mommy’s on the Phone

Mom gets a phone call while her 2-year-old son plays happily on the floor.  He’s very content, or well, he was until the phone rang. He always gets anxious when Mom gets on the phone, because her availability changes. That is, when she’s on the phone, he’s noticed that when he wants her, she says things like, “Wait,” “In a few minutes” and “Soon.”  That drives him nuts. What does she mean?  Junior has no real way of estimating how long Mom will be on the phone because he really can’t tell by who she’s talking to or what she’s talking about (reference points that we might use).  All Junior knows is how to get Mom off the phone, so he proceeds to put his finger in the electrical socket.

Behavioral Evidence of Not Having or Using this Tool

• Problems with waiting: does not make or makes poor estimates of how long to wait for things
• Problems using spatial reference points to determine where to stand or sit, where to go
• Difficulties understanding and using personal space
• Difficulties using the same reference points others his or her age; requires prompts or specific, overt directions when others can use natural reference points

Tool: Theory of Mind (ToM): ToM has to do with our knowledge of others’ knowledge states.  We use reference points such as other people’s eye direction, what we see them do; hear them say, etc. to make inferences about what they’ve noticed, seen; what they intend; what they believe, etc. Very young children have yet to develop their ToM (see Egocentrism, below), and it is notoriously deficient (not necessarily absent) in individuals on the Autism Spectrum.Theory of Mind is not a fixed trait.  We are born with a capacity to develop it (this varies among people) and we’re not born with it.  It begins to develop as the person develops forms of working and episodic memory that can support it.  Evidence (knowledge) from observing others has to be retained and differentiated as separate from what the IP knows and thinks. Very young children tend to integrate this information into an egocentric view of the world (see “Egocentrism” below). They have difficulty separating their subjective views from objective or others’ views of the world.

In other words, they assume that whatever is in their head must be in your head. This leads to erroneous assumptions about what you know or don’t know. For instance, a 3 year old assumes that Mommy knows where he is – because he knows where he is, despite the fact that he has moved from where she last saw him.

ToM exists on a spectrum of ability that ranges from very basic: intuiting that what a person experienced is what she knows (this is true for all senses), to “deep referencing:” a knowledge base of what a person knows, believes, intends, means by (what he said or did), wants, etc. Deficient social functioning can often be traced back to some level of deficient ToM.

Behavioral Evidence of Not Having or Using this Tool

• Lacks filters; says things without thinking of how they affect others
• Learns lessons vicariously; not reliant on direct experience
• Can learn from fables and metaphor
• Assumes others know or should know things
• Does not seem to take other’s perspectives or knowledge into account when problem solving

Tool: Repair: Relative to ToM, Egocentrism and something Piaget referred to as “equilibration” is the notion of “repair.”  Equilibration occurs when a person moves from a state of equilibrium (understanding of the object, event or circumstances) to disequilibrium (reality contrasts with the IP’s current understanding), and then, through learning, the IP comes to a new, expanded understanding (perhaps through the development of new concepts, skills or tools for learning) and a subsequent “new equilibrium.”To profit from equilibrium, the IP first has to realize that their previous understanding; their previous approach to a problem or a situation, no longer works. At first, the tendency of all people is to try to force new information into their existing way of understanding.  For instance, young children may be a bit unsettled if they encounter their Teacher at the supermarket. They might not be able to recognize her outside of the familiar context of school – at first. This cause a temporary state of disequilibrium, and the child may insist that it is not the Teacher. At this point, the child assimilates reality into her existing thinking. But, as the Teacher begins to talk and say, Hi,” the child comes to understand that the Teacher can exist outside of school (or at least at the school or store, but perhaps not the beach). Now, the child accommodates her thinking to the new reality.

This section would be remarkable if the Student tends to keep assimilating new information into old cognitive schemes (below).  This is both a behavioral and cognitive problem.  We see that the individual clings to static systems or existing schemes of the world.

Later on in development, a mature thinker can think of things he or she may have missed, rather than change only in the face of new realities. They can learn by taking others’ perspectives (by adopting a “Like me” position), engaging in hypothetical reasoning and testing their theories because they know they can be wrong.

Behavioral Evidence of Not Having or Using this Tool

• Recognizes own mistakes and makes efforts to fix them
• Makes deliberate, focused efforts to try and fix mistakes or solve problems
• Incorporates new and available information into thinking (flexible and responsive motor planning as opposed to ballistic motor planning)

Tool: Logical Reasoning: (For more detail, please refer to Piaget’s taxonomy of logical thinking, Concrete Operations Stage, below). Logical thinking is a broad category that refers to systematic thinking steps one takes in the pursuit of a solution to a problem.  This set of tools is almost entirely learned.  It involves choosing relevant from irrelevant information, considering those facts and ideas and using some kind of sequential thought process towards a solution to a problem.

Tool: Rule-Based Thought: Rules are special forms of antecedent conditions. When someone is following a rule, the trigger for their behavior in the moment my not be apparent since the rule may be an internalized one. Also, since rules antecede the circumstances in which they are used – we can tell when a child or Student is not following our rules. Children entering Kindergarten are already experienced in rule-based thinking, albeit on a very simple level.  “Don’t jump on the couch.” “Boys use the Boys’ bathroom and girls use the Girls’ bathroom.”  “Wash your hands before eating.” “Be quiet while the Teacher reads the story.”

Tool: Explicit Rules: Following rules explicitly spelled out requires the ability to remember the rule as well as to keep the rule “in mind” and “on-line” while interacting with the environment.  The IP has to be able to make judgments as to where, when and how the rule applies to various situations if necessary. At the age when rule-based thinking emerges, rule-following and rule-making are quite localized to certain situations where an adult demonstrates application of the rule and imposes consequences for following and not following the rule. The thinking is black and white. The IP will have difficulty understanding why the rules may have to be applied differently in one circumstance v. another or why the adult might have to make considerations for some and not others.  Fairness at this stage of thinking means the same rules for everyone – no matter what.At the other end of the intellectual spectrum, people can show abstract understandings of rules. They realize that rules are tools that we devise for our own benefit. They understand that rules are flawed just as people are flawed and life is irregular.  They may willfully disobey rules that they believe are wrong or “unjust.”

• Levels and Stages of Rule-based behavior by Lawrence KohlbergAs mentioned above, any analysis of Lawrence Kohlberg’s Stages of Moral Reasoning given here would not do it justice (no pun intended). Therefore, only a terse summary of Kohlberg’s hierarchy of rule-based behavior is given here.  Note that the taxonomy could be an excellent heuristic for analyzing the rule-based thinking of individuals with emotional and conduct disorders…

Level 1: Preconventional Morality: This is the level of moral reasoning and rule-following expected in Infancy to Pre-school. Individuals functioning at these levels beyond Kindergarten would be considered to be immature or to lack character.

• Stage 1 (Obedience and Punishment): The IP has little if any understanding of why the rule exists or how it serves the greater good. The point of life is to obtain reinforcement and avoid punishment. This level of moral reasoning is expected of toddlers.  Criminal often function at this level.
• Stage 2 (Individualism and Exchange): The individual still puts him or herself before the rule. There is still little if any real understanding of why the rules are there. Rules are made by “big people” or “authorities” and can therefore feel arbitrary to people on this level. The individual may follows rule they like and disobey rules that conflict with his or her wishes. Rules that result in not getting what he or she wants are deemed stupid or unfair.

Level 2: Conventional Morality: Most people in the world function at one of the two stages of Conventional Morality. They are capable of being functional citizens and to assume positions of authority (e.g., Parent; Teacher; Bureaucrat, etc.).

• Stage 3 (Interpersonal Relationships): Rule following is seen as a way to please others and to be sure that one is “doing the right thing.” This type of thinking is still quite concrete.  The individual follows and enforces rules in order to insure conformity and loyalty and to be sure that his or her own behavior pleases others. They likely do not understand the spirit of the law – and focus on the letter of it.  Individuals functioning at this level will follow enforce unfair rules in order to obey with the letter of the law.  Because of the lack of flexibility, individuals functioning at this level are prone to hypocrisy and to following rules to the point of harming others. These supervisors need supervisors.
• Stage 4 (Maintaining Social Order) The individual has some understanding of how rules serve the greater good.  People at this level and stage often make rules for themselves and others – understanding how rules tend to bring orderliness and serve to clear up misunderstandings.

Level 3: Postconventional Morality: The stages at this level represent above average reasoning. Rules have to be made and applied differentially.  These people tend to have some training and experience with critical thinking.  Because of this they are capable of making rules and enforcing them in a complex and diverse world and are often put in charge of the process.

• Stage 5 (Social Contract and Individual Rights): The individual can understand that laws and rules have to have exceptions and mitigating circumstances and that universal enforcement of rules can cause harm. They understand that flawed individuals make rules and that rules are by nature flawed and therefore fungible. They can take other perspectives into account – even those that they may not have heard before or that are very much different than their own.
• Stage 6 (Universal Principles):  This stage is theoretical. Some believe it merely represents the upper reaches of Stage 5.  Individuals functioning at this level follow their own rules and values, even though they may clash with societal rules and conventions. These individuals are prepared to suffer the consequences of following higher principles.Exemplars of this rule may engage in civil disobedience (principle based disobedience in the face of a rule deemed harmful or unfair). Some have led movements of civil disobedience or led movements of change that were far ahead of conventional thinkers and existing rules (e.g., Mahatma Gandhi; Joan of Arc; Martin Luther; Martin Luther King; the American founding fathers; Picasso; neo-Skinnerians that take developmental, phenomenological and contextual factors into account when performing Functional Assessments of behavior, etc.).

Tool: Implicit Rules: The individual intuits or abstracts rules by noting patterns of rule following in others. For instance, a Kindergartener might notice that girls use one bathroom and boys another.  The elementary Student may approach a table where other Students are working, and be able to tell what the rules are for sharing the objects involved by watching others.Implicit rules can be simple (as in the Boys’/Girls’ bathroom example), or exceedingly complex and seemingly arbitrary (e.g., the rules of fashion; art; politics, etc.).  Neurotypicals usually show good ability to infer rules of social interaction when interacting with those of the same age. One way to characterize the impairment of autism spectrum disorders is that it is very difficult for them to extract the rules of relating simply by observing and participating. This is why intervention often seeks to make implicit rules explicit for them.

Tool: Collective Goals: Goal directed and intentional behavior now becomes a collaborative, co-regulated type of thinking that the IP can share with others. Some Psychologists call this a “collective ego,” or ‘We-go’ (Emde, 1989), where the IP shares a mutual goal with someone else.  This is the essence of teamwork and group identity. The IP is able to balance and accommodate his or her own intentions and goal-directed behavior with those of others towards a commonly desired outcome.Naturally, a good deal of social, emotional and cognitive skills overlap to make up the IP’s capacity for we-go. In this section, we focus on the IP’s capacity to conceptualize the goals of a team, project, group, etc.  Not only can they describe the collective goals, they can identify their own contributions and personal goals in relationship to them. They can also incorporate other’s points of view into their thinking and motor plans by accommodating their thinking.

Behavioral Evidence of Not Having or Using this Tool

• Difficulty deriving rules from watching others’ behavior
• Difficulty staying within the rules when they conflict with the IP’s wishes
• May ignore logical reasons why people do things and attribute others’ behaviors to global or innate traits (because other people are “mean,” “stupid,” “smarter than me”)
• Attributes natural phenomena to magical, supernatural or other causes and overlooks logical causes
• Me First Thinking (Garcia-Winner, 2007): the IP does not typically or cannot take into account the wishes and needs of the group in his or her thinking

Tool: Perspective Switching: This ability represents a more robust understanding of other people’s points of view than simple ToM. This tool of thought allows the IP to “walk a mile in the other person’s shoes.” In other words, they can take into account not only what the other person knows and doesn’t know, but how the other person perceives and experiences the consequences of the environment. They understand how the other person’s role, gender, life-experience might lead them to think and respond in characteristic ways.

Behavioral Evidence of Not Having or Using this Tool

• Difficulty taking other’s experiences into account
• Difficulty considering others’ needs into account when making decisions

Tool: Metacognition: (For more detail, please refer to Piaget’s taxonomy of logical thinking, Formal Operations Stage, below). Roughly, metacognition refers to the ability to think about thinking – especially to think about one’s own thinking.  One can examine one’s own knowledge state, determine whether or not it is sufficient or not, and choose known tools and strategies for discovery. The IP not only knows what he or she thinks or what other people think, but how they think. Metacognition is about one’s ability to look at one’s own and others’ thinking with an objective, “observing eye” that can provide a corrective, self-regulating influence on thinking.

Behavioral Evidence of Not Having or Using this Tool

• Difficulty recognizing one’s own or others patterns of thinking
• Difficulty with reflection
• Difficulty with criticism

Tool: Critical Thinking: Critical thinking can be thought of as trained thinking. That is, critical thinking involves a systematic pursuit of a truth or testable theory that is uncommon among individuals without any type of formal education. There are many forms of critical thinking identified by logicians, philosophers, mathematicians and scientists.  The thinking process is systematic, and examines degrees of fact versus belief; degrees of truth (true, false, partially true or false, substantiated v. unsubstantiated, etc.).  The use of proofs is an example of this.

Behavioral Evidence of Not Having or Using this Tool

• Difficulty with higher order logic; has difficulty recognizing mistakes in thinking or logic
• Difficulty with ideas where there is no single right answer and many correct ones that might even conflict with each other
• Difficulty understanding that opposites can be true
• Difficulty understanding that rules are guidelines and are imperfect

Sensory, Concrete and Abstract Levels of Thinking
Jean Piaget’s Taxonomy

Piaget was a developmental biologist who developed his genetic epistemology (taxonomy) by closely observing and recording the intellectual abilities of infants, children and adolescents.  He used a case study approach, observing and testing and following his daughters through their development. He also performed tests of intellectual knowledge on many other children, and the field of Child Development continues to test his theories and any number of abilities children develop and how they develop it. The field of Child Development is and always has been considered a branch of biology.

Piaget tied his stages of intellectual to known developments in brain growth. The epistemology corresponds roughly to qualitative changes in the neurobiological systems of the brain (e.g., myelination; frontal/executive development; language), which can lead some to attribute psychobehavioral change to biological development.

But we know that this is not true. In the atypical development of children that experience deprived environments in early childhood, we can see deficits in brain development at the neurological systems level. In typical development, we can see that there are predictable sequences of qualitative leaps in thinking that are so universal that we can predict children’s readiness for certain concepts with some accuracy.  But this is not without environmental facilitation and the very real interaction between biological and environmental systems.

To be clear, the descriptions of the stages and the hierarchy of them given below is not to imply that behavior emanates from the stage. The information is most useful in providing information that helps us understand how the IP experiences consequences – in other words, their capacity to understand and benefit from them, as well as information about the IP’s readiness and capacity to learn replacement behaviors. The choice of replacement behaviors should reflect the IP’s processing capabilities, as well as the processing requirements in the environment that do or do not facilitate adaptation for the individual.

Usefulness of Piaget’s taxonomy/epistemology in Functional Assessment of Behavior:

• Can identify the processing demands of tasks, problem-solving and other adaptations to the environment (i.e. good behavior)
• Can identify the IP’s extant processing capabilities and therefore help to identify discrepancies in readiness or skills (missing skills) that may be functionally related to the behavior under assessment
• From the discrepancies, interventions can derive a list of skills needed
• From examination of the processing demands involved and those currently within the repertoire of the IP, the Analyst can choose replacement behaviors to teach with more precision
• From knowledge of specific neurological/learning processes, the Analyst can be in a better position to choose teaching strategies that will work
• The epistemology not only describes behaviors typically observed in clusters at given stages of the hierarchy (content), but learning processes (i.e. “means” “tools”).  Interventionists can then teach pivotal learning skills (tools), rather than treating only symptoms

Characteristics of Learning

Assessing the content of the IP’s overt skills is a fairly straightforward enterprise that can be accomplished with simple inventories of behavior. In other words, it is easy to measure what the IP can do and cannot do.

It is more difficult to assess intellectual processes. Much of the activity is covert. Psychoeducational testing and systematic developmental observation can provide important supplemental information to inform not only baseline logic, but to buttress the Analyst’s theory of the behavior.

What is Developmental Observation?

Developmental observation is required in this method. Developmental observation has several forms:

Simple Developmental Observation (Unstructured): This can and should be done over several days and across settings. The Analyst observes the child at play, socializing, and solving problems encountered in the IP’s natural environments. The Analysts looks at the means of exploring, discovery and problem solving the IP uses.Observations of toy and dramatic play can be particularly revealing in the case of younger children. People have a strong tendency to reveal who they are by what they find interesting or not, and howthey pursue what is interesting to them.A related process can be done with error analysis of an older individual’s academic work and performance on tasks.  From this data, the Analysts looks to the hierarchy to identify skill clusters that match other behavioral clusters found in the stage.Skills tend to cluster along a bandwidth or range of skills in most individuals. Developmental analysts look at where the majority of skills seems to be (the “Functional range”), and the upper (“Ceiling”) and lower (“Basal”) ends of the range.

• Basal Range: This is the range of skills already acquired and comfortably used by the IP. These skills are relatively solidly established, and are reliably used by the IP even when compromised (e.g., tired, hungry, irritated, etc.).  These skills also tend to be used in novel or challenging situations.
• Functional Range: This is also a range of skills already acquired and fully in use by the IP, but that may not be evident under special conditions of compromise, novelty or challenge. The skills are generalized for the most part and therefore useful in most settings and most situations for the IP.
• Ceiling Range: This refers to the ZPD. The IP may possess scattered or weakly developed skills in this range, or may only be able to do them under certain conditions or with support. Skills are unreliably produced in this range.

Structured Developmental Assessment: The Examiner exposes the person to toys and objects that children tend to play with at different stages of development. Typically, the Examiner has toys available in a play room or assessment environment for the IP to select (for older children, other objects can be used). As mentioned, the selection of objects/toys can reveal important clues about the IP’s development, as well what they do with the objects when they interact with them.

Developmental Inventories/Checklists/Profiles: These are lists of behaviors typically seen at the various stages of the hierarchy. This is best done face-to-face with an informant, using a criterion-referenced assessment tool. Informants are people that by virtue of their familiarity with the IP, can answer items on the developmental questionnaire. Typically, those are the Parent(s), Teacher(s) and often, the IP.  The most popular and well-regarded Developmental Inventories/Checklists have separate forms for Parents, Teachers and Child (IP).It is not a good idea to simply hand a Parent (or especially a child) a developmental inventory/checklist and just ask them to fill it out. That is because there can be (and usually is) room for different understandings of items on the test.  Since these are criterion referenced measures, the IP cannot fail it, and the score derived from the test should never be used for making any sort of decision. Used properly, a developmental checklist or inventory should not resemble a test. It is merely a tool to guide observation and to organize the data.

Caution regarding assumptions made from the data: The Analyst has to be an intelligent consumer of developmental checklists. He or she has to look at the items on the checklist to determine whether the tool has a bias towards skills that are normally taught using behavioral teaching methods. For instance, the IP may be able to tie her shoes, but the rest of her development does not match this level of skill. That might be because the skill might have been taught using behavioral shaping and chaining procedures that produce reliable but rote performance of specific adaptive skills. We want to be sure that we are measuring developmental processes, not just acquired skills.

Extreme caution regarding the reporting of Developmental Age(s): Many commercially available developmental checklists yield a “Developmental Age” from the data. Items are weighted by scores for each item that denote the level of skill achievement is concerned. For instance, an inventory item such as “names at least one color correctly” might be answered with a 0 for “never” or “not at all;” a 1 for “sometimes;” or a 2for “always.”  A total of the scores are added up and compared to scores obtained from a normative sample. The “developmental age score” equates the IP’s raw score (number of items correct or sum of the item scores) is the same as the average raw score for the normative sample of a specific age or grade. Age equivalents are written with a hyphen between years and months (e.g., 9–4 means that the age equivalent is 9 years, 4 months old). A decimal point is used between the grade and month in grade equivalents (e.g., 3.2 is the third grade, second month).Developmental age scores do not reflect developmental stages. They try to do what standard scores do – provide a score that is useful for comparison among individuals. But standard scores do this by converting data into equal intervals. So the difference between a score of 102 and a score of 105 is the same difference as any other two scores that are 3 points apart.Now consider the qualitative differences between development at 11 months and 30 months – a difference of 19 months of development. Typically developing children are vastly different people at these two ages.  Now consider the difference between two individuals where one of them is 56-4 (56 years and 4 months old) and a person who is 57-11 (a difference of 19 months) means what? These scores point out that “months of development” are not equal. It gets even worse when the tool asks you to add up and/or average the scores of different domains of development to yield a so-called age of ‘Overall Development.’ An even more egregious is the practice of taking the derived developmental age scores from various domains of development and adding them or averaging them.

Developmental Observation Tools: This involves the administration of test tasks or the presentation of specific materials to evaluate the IP’s interaction with them.  The Examiner presents specific “stimuli” to the IP and records the types of responses given by the IP.  For instance, the Examiner might present a simple 3-piece formboard puzzle (insets: circle, triangle, square) to the IP.  If the IP does not use it at all or uses it inappropriately (e.g., puts the puzzle pieces in her mouth), a score of ‘0’ might be given.  If she performs the task using random trial and error, a score of ‘1’ might be given, and if the IP places the pieces in the formboard by looking at the pieces and the inset shapes and then puts each piece in with accuracy and certainty, then a score of ‘2’ might be given.

Developmental assessment should always involve the use of unstructured developmental assessment across a time interval (less than a month) and across settings (home, school, community, peers).

Characteristics of Learning: Mechanisms of Development

Piaget attempted to equate processes of thinking and cognitive development to processes of adaptation he observed in biology. In fact, he regarded learning as a process of adaptation. He explained cognitive adaptation as a process of equilibration that has two mechanisms driving it: “assimilation” and “accommodation.” As a result of this process, the child develops models of the world, otherwise known as percepts, concepts, skills and thinking processes. Piaget called these schemes or schema/schemae (plural). A scheme is something a person knows how to do or understands. As children learn, cognitive schemes become more complex, elaborated and differentiated, as do all systems undergoing development. Development therefore represents not only the growing number of schemae the IP has, but also the degree of complexity, elaboration and differentiation of and between schemae. Piaget’s epistemology/taxonomy provides us with a road map of schemae through the course of typical development. That is, each stage consists of certain kinds of schemae that are different than those that develop at other stages. As Behavior Analysts concerned with teaching replacement behaviors, we want to look at the schemae the IP currently has (as behavior reflects the IP’s current understandings of the world), as well as the ways the IP tends to develop new schema.

Equilibration: Equilibration is a way of explaining the adaptation process. Piaget’s equilibration theory maintains that when a person encounters something new or that doesn’t fit into their current understanding, an imbalance is created that requires restoring the balance, or re-equilibration. Specifically, it involves how learning and new schemae develop from a process that moves from equilibrium to disequilibrium and back again to a new equilibrium (represented as a new scheme).

Equilibrium is the state of current knowledge. It remains stable as long as reality does not contradict the person’s existing understanding.

Assimilation: When a person encounters new information, they usually have little choice but to approach the information with their current means of understanding (scheme of things). If the person continues to change reality to fit their current knowledge, they are assimilating. New information is somehow forced into an existing template of reality in the mind.

Once, I had a chance to see the process slowed down in a 17-year-old individual with both autism and severe intellectual challenges. We were at the zoo. He was able to correctly identify that the animal in the exhibit was a bear. The bear jumped into the pool for a swim, diving under the water. He then declared that the animal was a fish.

This 17-year-old altered reality to fit his existing schemae of bears and fish. In other words, he assimilated reality into his current understanding of the world.

Assimilation of new information is not abnormal. It is a typical part of learning new things or encountering new realities. Adaptation takes place when the person develops a new understanding that can accommodate the new information. The 17 year old in the example did not accommodate his thinking in the above example, and I’m not sure if he ever did.

Failure to accommodate new information and change one’s mindset is the hallmark of inflexible thinking, rigidity, emotional disturbance, stereotyping, bigotry and other forms of maladapted thinking. Failure to accommodate thinking or persistent assimilation of new information can be quite problematic as adaptation continues to fail to occur. It is often a component of “problem behavior.”

Accommodation: Accommodation comprises the other part of the adaptation process. It involves changing one’s existing schemas, or ideas, as a result of new information or new experiences. New schemas often develop as a result of accommodation.

We have hairless cats in our office, so I get to see people accommodate their notions of cats, rats and dogs all the time.  People see them and they often say, “What is that?”

They are cats in every way, but they don’t exactly fit most people’s experience, unless they’ve heard about the breed. Admittedly, a cat without hair looks weird. Those that have seen a shaved cat know what I mean. Our cats have long tails as cats do, but a hairless tail on a 4-legged animal gives them a rodent-like appearance to some people. They also have very big ears that stick up so they look a bit like Chihuahuas, and people often mistake them for dogs. When we tell folks that they are indeed cats, people aren’t exactly astonished – not even children (in fact, they seem to have less of a problem accommodating this), but their process is revealed when they say, “Oh wow, interesting.” After a few minutes of watching their very cat-like behavior, we see most people successfully accommodate this ‘new information.’

Object Permanence: Piaget developed his own concept of object permanence as a form of memory. He defined it as the ability to understand that objects continue to exist when the infant closes his or her eyes, or even when the object is no longer present. Prior to that, an infant may no longer show interest or pay attention to an object (evidence of holding the representation in mind) once it is no longer stimulating the senses (no longer visible, audible or tangible).

We note here that the term “object permanence” can have a different meaning in “Object-Relations” psychology (a branch of Psychodynamic psychology), and that we now know that there are many different forms of memory.  What ties all of these notions together is retention and representation in the mind. As can be seen in the taxonomies above, mental representation is a tool that ‘comes on line’ early in typical development (in the first year), and continues to expand in capacity and elaboration through the lifespan.

Piaget maintained that object permanence constituted one of the most important accomplishments in development, because without it, objects would not exist outside of the person’s experience. According to Greenspan, before object permanence, infants believe that they create Mommy by opening their eyes, and make her go away when they close them. We can see that ‘pre-conservational’ children do not ‘hold on’ to perceptions, which is why they may believe that the sun just goes away or disappears at night; why toddlers might not want to complete toilet training for fear that if Mommy doesn’t have to take care of them, Mommy will cease to exist (toddler often believe that they were born before their parents and that their parents only reason to exist is to take care of them); why preschoolers believe that the same amount of water poured from a tall glass into a dish is somehow a different amount; and why concrete thinking children cannot grasp math calculations involving the variable ’x’ – a number that does not exist in permanent form.

Egocentrism: In psychology, egocentrism implies a preoccupation with one’s own reality and interests and a corresponding lack of concern about others. In that sense, egocentric people are more narcissistic than others their age, and place their own interests and opinions before those of others. Egocentrics have difficulty understanding or coping with other people’s opinions and the fact that reality can be different from what they are ready to accept. The highly egocentric person can have difficulty distinguishing between subjective (personal or private) and objective (public knowledge) reality. They may believe that those who have a different perception than their own are false or nonexistent.

Piaget believed that egocentric children use language primarily for communication with oneself. Indeed; walk into any kindergarten and you will children talking to themselves out loud. I believe that this phenomenon is better explained as the cognitive tool of self-directed language in the process of going from overt to covert, as described by Vygotsky (see “Private Speech” above).

Piaget demonstrated children’s’ egocentrism using his famous “Mountains” test.  He placed the child in front of a simple plaster mountain range, while he sat on the other side of it. He then asked the child to pick from four pictures what he or she thought that he, Piaget, would see. Generally, before the age of seven, children picked the picture of the view they themselves saw. We can see here that egocentric thinking has to do with the development of Theory of Mind (ToM). It takes ToM to appreciate a viewpoint different from one’s own. Egocentricity therefore is analogous to a certain level of deficiency of ToM. Piaget found from many of these tests, that concrete-operational stage of development tend to become less egocentric and begin to appreciate viewpoints other than their own. In other words, they became capable of cognitive perspective-taking.

For our purposes here, egocentrism has to do with the development of the mental tool of ToM. It has to do with the IP’s relative ability or difficulty understanding other’s points of view. Egocentric thinking assumes that one’s view of the world is the same as other peoples’. Egocentricity may look like selfishness, but may only represent an inability to take another person’s perspective. Difficulties understanding other’s perspective can be quite subject-specific and exist to some degree in all of us at any time in our lives. Does everyone see things the way you do? Haven’t we all encountered others that cannot empathize with us? Here again, egocentricity is a mental ability that is learned and that emerges at fairly predictable stages of development, but then increases in elaboration, integration and complexity with experience and maturity.

Logical Thinking: Some developmentalists see the entire range of human intellectual development as the expansion of logical thinking. They see forms of logic in the earliest stages. I am one of them. But Piaget saw logical thinking as an operation, or a stepwise process of thinking applied to a problem of reality. Therefore, he considered pre-conservational children as ‘pre-logical.’

In a broader understanding, logic is the formation of some sort of inference. If Greenspan is right, the very young infant infers that she makes Mommy come and go by opening and closing her eyes. The child that infers that the wagging tail under the couch means that the dog is under there – is making an inference.

Conservation refers to a set of logical thinking abilities that for many, characterize and define the concrete operations stage of development (below). The development of conservational thinking means that the child is becoming less bound by their immediate perception. They can conserve the essence of something as it undergoes transformations of form. Most readers of this manual are familiar with Piaget’s famous “conservation tasks” that he used to test children’s abilities to understand that some properties of objects are “conserved” or invariant after undergoing physical transformation, such as a row of coins being stretched out, or a lump of clay being rolled into a tube. The most famous of these tasks is when the Examiner pours water from a short and wide glass into a tall and narrow glass. The pre-conservational child will be adamant that once the water is in the taller glass, that somehow it is now “more.” The Examiner then pours the water back into the short glass and the child now declares that it is less. Pre-conservational children cannot understand that the quantity of water will remain the same despite adjustment of the container, shape, or apparent size.

Conservation task tests have been replicated in children many thousands of times in children all over the world. They are not just little tricks. In education, conservation is an essential mental tool that allows children to understand reversal of amounts (3+4 = 4+3) for instance, as well as other forms of transformation (see Concrete Operations below). In psychology and emotion, conservation applies to an individual’s ability to retain the essence of a person as they play different roles or function in different settings (i.e. as in the examples of the child seeing his Teacher in the supermarket or the 17 year old that believed that a bear turned into a fish by going in the water.

Abstraction: The ability to think abstractly has to do with a person’s ability to think of things that are not immediately perceptible through the senses. Abstraction has to do with thinking outside the here and now; thinking about attributes and relationships between ideas that separate from the objects and actions in one’s direct experience.

Abstraction refers to “pulling out” attributes of what happens and what is and applying the concepts in a general way to other things.  Notions of object permanence and conservation described above are examples of this. That is, we “know” that an object exists outside one’s presence, but the notion that we accomplish the feat of object permanence by creating a representation of it in the mind is an abstraction.  We cannot see the representation, but we know that a mental representation has to exist in order for mental object permanence to exist.

The development of abstract thinking follows the rule of systems in that it represents more complex, differentiated and integrated forms of thinking than prior forms – in fact, it epitomizes this rule. There are many types of thinking that we can call “abstract,” some of which are discussed below.

For an example of this, less look at what is generally an acquired taste for most – wine. I don’t know of many people that liked wine the first time they tried it, but many people certainly become fans if not connoisseurs of the stuff.  If we follow the course of development from neophyte to connoisseur, we see we can see the epistemology of wine leads to ever-increasing levels of:

• Complexity: The connoisseur understands the various and subtle flavors in the wine, appreciating “notes of (this or that)” “body” etc. They learn how wine making techniques, regions, climate, varietals, etc. influence wines and they know of wine markets and prices, trends and all that good stuff.
• Differentiation: With my eyes closed, I might be able to tell the difference between wine and milk. I don’t claim to be a wine connoisseur. A blind-folded connoisseur can tell subtle differences between wines that might taste exactly alike to the rest of us. Experts seem to be able to tell you the region, the farm and the side of the mountain in which the wine comes from.
• Integration: The connoisseur can compare and contrast numerous tastes and facts about wine.

In contrast to the connoisseur, I would be considered pretty “concrete.” Since my taste buds aren’t up to the task, I might have to see the wine in order to know whether it is red or white. I might wonder aloud why white wine is really yellow. I might believe that a “Cab” refers to a form of transportation for hire, and not a Cabernet. Sherry and Rose are friends of mine.

While some might disagree, I believe that I am capable of abstract thinking – in other domains of life, if not wine. This illustrates the domain specificity of abstract thought. In the individuals that we serve, we can see that they may be able to think with relative abstraction and complexity in some areas, but not in their area of specific disability. In the areas of their disability, we might see levels of logical thinking (see table below) relatively far below (discrepant with) their development in other areas.

Characteristics of Learners
The Basic Framework: The Four Periods of Development

Piaget’s epistemology/taxonomy has four major levels in its hierarchy that cover the development of logical thinking from birth to adolescence.  The first major stage, the “Sensorimotor Period” has within it, 6 qualitatively different substages. The Preoperational Period, which follows the sensorimotor period, has two substages. The Concrete Operations period covers the elementary school years, and the final stage, the period of Formal Operations, begins in adolescence and then undergoes refinement (increasing complexity, differentiation and integration) for the rest of the lifespan.

Piaget’s stage model has been tested and debated by Piagetian scholars and researchers ever since.  There is debate as to when certain stages actually begin, especially the early infant stages, because infants and young children may not be able to show their understanding through motor actions.

The sequence and qualitative features of Piaget’s stages are not as controversial, but as with any other scientific matter, it has been challenged by other theories and points of view. However, the research evidence that confirms the basic framework and sequence is robust.

To be fair, and since the functional assessment of behavior is an applied behavior analytic procedure, we should consider the issues behavioral science has with Piagetian – or any other stage theory of development.

Valid Points and Cautions

I have been clear here that the taxonomies of development listed in this section are useful only as heuristics that can inform our baseline logic. Neurobiological development and maturation with age do not bring about the qualitative changes in behavior that mark these stages.  Rather, I happen to agree with neo-behavioral theorists in what is called the contextualistic model.

“The contextualistic worldview treats behavioral development as the result of a dynamic interplay between and individual and the environment. Under this model, both the individual and the environment participate in development. The behavioral changes are the result of learning, and they are both qualitative and quantitative in nature. Development does not follow a series of predetermined stages, but can proceed along many different paths depending on a history of dynamic interactions and the contextual determinants operating at a given moment.” (Novak & Palaez, 2004)

As far as I know, Piaget never claimed that behaviors resulted because of a stage.  That notion is a favorite straw man to behaviorists.  If Piaget ever did make such a claim or implication, it does not matter here, because we are not looking for explanations of development here.  We are looking for a way to organize our knowledge of behavior and to be able to select replacement behaviors to teach that are most likely to work.

Perhaps the misunderstanding comes from Piaget’s belief that behavior and thinking reflect the growth of underlying mental (neurobiological) structures.  Neuroscience is not there yet. We cannot point to specific neural circuitry for behavior or conceptual development, but we can be sure that the brain changes with any form of learning.  And we also know that without genetic, innate neural structures, certain types of learning cannot occur.

Another valid caution is that developmental taxonomies do not provide explanations of development – only descriptions of the contents of a stage or level. There is little information one can derive from examining any stage that can provide us with an explanation or mechanism that brings the individual to the next stage.  That is why we want to focus on the means of acquiring knowledge within these stages, as we looked at Vygotsky’s tools of the mind. For instance, once an infant masters coordination of visual and motor skills to accomplish reaching and grasping, reaching and grasping becomes means of exploring and learning from the world.  It is the development of means of exploration and problem solving that are remarkable in this section.

The Sensorimotor Period (0 – 2 years)

The Sensorimotor stage occurs in typical development between birth and 2 years. During this stage, infants and young toddlers learn about the world primarily through sensory activity such as seeing, hearing, and tasting and motor action (e.g., moving, reaching, and touching). The primary “developmental tasks” of the sensorimotor period are for the individual to refine his or her perceptual abilities and form basic schemes (models) of the world and; to coordinate and integrate sensory perception (input) and motor action (output) into an organized and coherent whole. Toward the end of the stage, babies acquire the ability to represent objects and events in term of symbols (see above). These symbols take the form of words, simple sentences and imitation (which allows them to learn by observing others and to represent their world in representational play, see above).

The Period of Pre-operations (2 – 7 years)

Toddlers learn how to represent the world using symbols such as words, toy figures, drawing, imaginary play and other forms.  With this ability, they can talk about objects, people and events that are not present or within sensory reach, and they can engage in “mental time travel:” thinking and communicating about ideas remembered from the past or imagined to happen in the future.

In terms of their object concepts, toddlers and then preschoolers see tangible similarities and differences in objects.  This is the beginning of “classification.” They can match and sort them by shape, color, function, who they belong to, etc. They can understand relative or “ordered” relationships (e.g., bigger/smaller than, more/less than, long, longer, longest, first, next; before/after; today, tomorrow, yesterday, etc.).

In terms of reasoning and logical thought, preschoolers move from the simplest notions of cause and effect from the sensorimotor period to the realization that everything has a cause.  If they cannot observe the direct or obvious cause, they make up an explanation that fits their perceptions (early: the sun goes down; later: the sun goes to sleep).

At the later ends of the stage, children begin to understand other points of view can be different than their own. Earlier, they tend to believe that others know what they know and share their point of view.  For instance, 5 year olds may speak to each other, but each side of the conversation may not really consider what the other is saying.

The Period of Concrete Operations (7 – 11 years)

At the end of the pre-operational period, children begin to grasp that an object (physical and animate) remains the same even if its appearance changes.  However, it is not until the thought process becomes an operation (a series of actions or thoughts on an object or concept) that can be reversed, reformed, regrouped or otherwise re-ordered, that the child would be considered “operational.”  To be operational in the general sense, the child must be able to “conserve” essential characteristics of people and objects (“identity:” e.g., the Teacher is the same person if she is in the classroom or at the store; an array of coins is the same and not ‘more’ when it is spread out or contracted in space). The child must also be able to understand that a change in one dimension can be compensated by changes in another (“compensation:” e.g., amounts can be grouped and regrouped (6 + 1 = 5 + 2). And finally, the child must be able to comprehend that steps can be reversed forward and backward (“reversibility:” e.g., 5 + 4 = 4 + 5; 6 + 5 = 11… 11 – 6 = 5).

The Period of Formal Operations (7 – 11+ years)

The stage of formal operations represents the final major tier of Piaget’s hierarchy of cognitive development.  Children may enter the stage at 7 years old or later, and according to Piaget, not all people achieve this level of thinking.  As with the other stages, the characteristics of thinking that emerge in this stage should undergo a lifetime of further elaboration and refinement.  Formal education in critical and logical thinking, as one might obtain in high school or college, can result in even larger qualitative changes in thinking.

There are a few broad types of thinking that emerge in this stage. Perhaps the most defining characteristics are the emergence of abstract thought processes (there are several major subtypes); the ability to think about one’s own and other’s thinking – something called “metacognition;” and hypothetical thinking (thinking about what is not there but might be; thinking in terms of changing variables – as in algebra or social science).

Do we ever complete any of these stages?

The answer depends on how you look at it. If we look more closely at the stages of learning that we go through when we learn a new complex task, we can see the stages of learning at work at any time in life.

Learning a New Dance

This is an excellent metaphor as well as a concrete example.  You’re learning a brand new dance, and, let’s say you’re just an average dancer. In the beginning, you watch and imitate carefully.  You are very aware of your body, and in the midst of your concentration on your body, you are aware of the feeling of your movements.  Your movements are tentative – not confident or smooth.  And you are very likely not to notice many of the little things going on around you while you learn and practice.  In order to talk or to concentrate on what someone else is saying, you probably have to stop the dance movements temporarily. At this point in the learning process, you interact with the environment with your sensory and motor processors in the lead.  You are not thinking in symbols and you are not ready to dance with others that are quicker and smoother and more capable of making quick adjustments than you are. They would have to slow down and adapt to you!

As you practice, you get good enough so people don’t have to stop when you get lost. You can keep up if they do it the way you’ve practiced.  You can dance, but you can’t do much else while dancing because you still have to think about it. You are functioning mainly on perceptual knowledge.

After a while, you get good enough to do the dance with various songs that have the same beat.  You can go faster and slower, but your moves are not so well established that you can elaborate on them much. You can manage to talk and smile, but if you had to learn a new dance, you would probably have to start slow and build up the new moves. You’re pretty concrete as a dancer.

You ARE a good dancer.  You’ve been practicing this dance move – as well as others, and your skills from each dance begin to make you a faster learner of other dancers.  You can improvise and blend dance moves.  You are in dancing formal operations.

You are an amazing dancer. You’re in the Top 10 of “So You Think You Can Dance.” You meet the choreographer on Tuesday and she shows you your next routine.  It has 3,154 new moves, which you are able to perform near perfection two days later on live television.  That is because 3, 120 of the moves just seem to come from some motor script that you’ve stored in your cerebellum ever since – who knows?  You don’t think about it and you did, you couldn’t explain it (how do you explain that you how to stand on your toes for 8 minutes?).  If you or your partner makes a mistake, you can improvise a move to fill in the gap (repair) that the rest of us wouldn’t even notice.  You’re 17 years old now and have been in dancing formal operations since the age of 10 (who else can do this?). You are on a lifetime quest of ever-increasing complexity, differentiation and integration of your dance skills.

Think of learning to drive a car for the first time; to play the piano; to swing a golf club, etc.  You see similarities in these learning processes: sensorimotor → perceptual → concrete → abstract (fluid).

The metaphor of a dance is an apt one, because some people in the field of autism intervention refer to social interaction and human reciprocity as a dance. That is because natural social interaction is dynamic (ever-changing, spontaneous, ongoing and usually fluid). Participating is like dancing with partners – unrehearsed.  But unlike dancing, where only a fraction of a percentage of the population achieves high levels – social interaction, something we all do, is common.  Children at the age of 5 are capable of “dancing” at this high level.

Detailed Descriptions of the Stages

Piagetian stages are defined by their characteristic means of thinking and exploring the world. Each stage represents a different level of equilibration. The question for behavior analysts in this respect, has to do with whether the IP’s types of thinking and exploring the world result in positive adaptation. For this to happen, the IP must be able to engage in the type of thinking required by the demands of the environment. Therefore, the analyst performs parallel analyses: 1. the thinking demands of the situation and; 2. the thinking skills the IP brings to bear under the circumstances. Here again, the would-be analyst is reminded that a discrepancy between the two is very often a setting condition for the behaviors under assessment. Therefore, the last step is to determine whether the discrepancy in fact does create setting conditions for behavior.

The point of Piagetian or any stage-related assessment is not to identify the stage or the age in which it is supposed to occur in typical development. Besides proving useful in identifying discrepant forms of thinking, the heuristic should prove very helpful in the selection of Functional Equivalent Replacement Behaviors and teaching methods that are more likely to work.

Sensory Motor Stage and Substages

Sensorimotor Substage I

Reflex Schema (0–1 months): Infants at this stage are calibrating and learning how to use their sensory and motor nervous systems on the world outside the womb. When we are born, we have a certain amount of sensory and motor equipment already in place and functioning, but it has not yet been adjusted to the outside world. The brain represents an “experience-dependent” organ. Infants have to learn how to use it (don’t we all?). Babies have to learn how to make sense of wave (vision: light waves; audition: sound waves), chemical (taste and smell), and; gyroscopic (vestibular and proprioceptive) information. For instance, developing basic vision involves learning to focus the cornea – something the infant has to “learn” how to do. Before this happens, most vision is blurry – including faces. (Human infants are unique in their interest in the human face. The face is a very complex stimulus that only humans can make sense of. Infants aren’t born with that ability – only the interest. Contrary to popular belief, the newborn is not able to see the mother’s face clearly.  What the infant sees is the dark blobs that are the eyes, nostrils and mouth of the face. These dark blobs, and the sounds that emanate from it are enormously interesting, and the “wiring up” or “calibration” process of refining visual focus occurs amazingly rapidly considering the complexity of the face.)

Babies also develop a sense of interoception – the ability to make sense of information and feelings occurring within the body. Interoception is an important feedback channel for one’s own movement. While movement is reflexive and spastic in newborns, they are born with the abilities to suck (necessary for feeding from a nipple), close the hand (believed to be a remnant of our primate ancestry where infants ride their mothers by grabbing onto the hair on their back), and, by the end of this very short stage, to track the movement of objects.

Sensorimotor Substage II

Primary Circular Reactions (1-4 months):  Visual and audio tracking undergo further refinement as infants learn to notice objects and follow their movements.  This has to do with further refinement and experience managing the ocular-motor apparati that shift visual attention in short bursts of sequential movement (called saccades) and changing and sharpening focus. The internal mechanisms of the ear also learn to move to focus on sounds – much as radar dishes move to track radar waves. Our outer ears (pinnae) don’t move like those of other mammals – as we see the pinnae of horses, cats or dogs do, but the mechanisms of vibration reception (the bones of the ear: malleus, incus and stapes), do move ever so slightly towards the sound source).  Infants at this stage are learning to locate sound and to be able to tell the difference between sounds.  By the end of the stage, the infant responds differentially to familiar images and sounds (including mother’s face) and we can see the infant showing anticipatory responses to familiar events (such as opening the mouth for a spoon).

Sensorimotor Substage III

Secondary Circular Reactions (4-8 months): This stage is marked mainly by the emergence of ability to respond to perceptions with action. It represents the primitive beginnings of intentionality. The child can now look at an object and perform a simple action such as reaching or swatting.  Grasping typically emerges at the end of the stage.  At this stage, actions are quite simple and repetitive, and don’t accomplish very much.  Instead of coordinated gross or fine motor movements, mental development remains concentrated on sharpening perception and learning to use facial and oromuscular movements to express one’s self emotionally, makes sounds, or respond to others’ emotional signals.  At this stage, children are fascinated at what they see, but typically do not recognize their own hands and feet as part of themselves.  Therefore, they do not mentalize actions yet, and cannot coordinate them into intentional behaviors.  While the infant’s actions may be intentional, the motor coordination isn’t there yet to be able to intentionally vary them or adapt them to a different situation. Children at this stage tend to repeat similar actions on the same object.

Sensorimotor Substage IV

Coordination of Secondary Schemata (8-12 months in typical development): This stage marks the beginning of what is called “intentional behavior.” Piaget saw the achievements of this stage as among the most pivotal in development.  These achievements include the development of intentional behavior; development of a primitive sense of causation, and; object permanence (the ability to form and hold representations of the world in the mind).

At this stage, the child responds in order to produce a desired result, and will respond similarly in a new situation. These behaviors indicate that affect (the desire or wish) is now becoming connected to motor plans (sequences of actions) that produce a desired outcome.

Also among the primary mental achievements of this stage include the development of “symbolic meaning.”  This means that through beginning memory (“object permanence”) permanent mental representations of sights, sounds, smells, feels, and tastes, conjure up associations with specific objects, people, or events.  This why at this stage, an individual can be very motivated to understand new objects using his or her proximal senses (i.e. by mouthing, feeling, banging, pushing, pulling, etc.), and repeating the actions in order to make meaning of them.  An important and related developmental task will be to integrate various sensory perceptions into richer, multidimensional mental representations (i.e. the sight and the sound; the smell, the feel, and the taste; what happens when an object moves, falls, or hits another object, etc.).

When a child has mental images to operate on (as opposed to immediate perceptions), he or she can now begin to use previously learned physical skills (i.e. reaching, grasping, turning, pulling, pushing, etc.) in order to explore the world.  Throughout the stage, the child is grabbing, mouthing, and performing other types of sensory experience-seeking actions in order to learn.  These sensory experiences help a child to refine his or her mental ability to discriminate and differentiate sensory information, although many of the sensory-seeking actions taken can be simply to experience the pleasure (or comfort) of sensations.

Importantly, a fundamental achievement of this stage is to learn to coordinate physical (fine and gross motor) skills with internalized mental images and emotions (desires, persistence, feelings).  When a child has difficulty coordinating his or her intent with controlled and sequenced physical actions (which can include speaking when that develops), they can become locked into repetitive behavioral patterns, and consequently, have difficulty developing more systematic and imaginative types of thinking and play later on.  It is often the difficulty with integration of senses, mental images, and physical actions that skews further development in pervasive developmental disorders.  Therefore, repeating actions is very characteristic of this stage, but mastery of the stage means the child can move on to develop ever increasing and varied means of exploring and combining objects and actions.

Sensorimotor Substage V

Tertiary Circular Reactions (12-18 months): Increases in physical mobility that normally accompany this stage (typically, children begin to walk or cruise, or if not, can crawl fairly well) can take an individual further out into his or her surroundings, increased exploration is now possible.  While intelligence consisted mainly of applying familiar skills and information to new situations in the previous stage, Stage V is marked by the invention of new skills in order to solve problems. Random trial and error begins to replace repeated actions on objects as a primary means of exploration. Characteristic of this stage, a child begins to discover very simple notions of physical “cause and effect” (in typical development, “social cause and effect” has been established much earlier in the forms of shared attention, the giving and returning of social smiles, etc.). Sometimes, to the consternation of adults, a child’s persistence and a tendency to repeat actions over and over out of fascination and a desire to master and internalize experiences is still characteristic of this stage, although the means of exploration are ever expanding. Actions such as throwing, knocking things over, banging them together, dropping them from high chairs and the like can be taxing to adults, but are normal and necessary to promote further mental development.

To a limited extent (usually towards the latter part of this stage), symbols such as pictures, gestures, or words can conjure up mental images, and children at this stage become interested in the symbolic world as represented by songs, books, videos and the like.  An individual’s active exploration can now make use more simple schemata that he or she has learned previously, such as reaching, turning, pulling, pushing, and other basic types of gross and fine motor manipulation. Typically, the child is fascinated by the discovery that objects can go together by putting one inside the other, fitting them together, placing them on top of each other, etc.  The child explores various iterations of means-end knowledge and through the process of trial and error becomes more able to solve new problems.

Of no less importance, the ability to operate on mental images allows a child to learn by imitating actions seen, or sounds heard. The ability to learn by watching or hearing opens up opportunities to learn from a distance (as opposed to the more “proximal” senses of taste, feel, and smell), which is a fundamental building block for language and can hardly be overestimated.  Because imitation requires mastery and coordination of multiple sensory data and reflexes, a child’s ability to imitate in Stage V is typically limited to copying actions immediately after witnessing them, and very limited ability to retain the complex combinations of motor, sensory, emotional, and thinking skills into integrated perceptions that can be stored in memory. Operating from internalized memories of actions experienced distally (through seeing or hearing), is a development associated with Stage VI. Therefore, the primary mode of learning at Stage V still consists of random trial and error approaches, rather than through rehearsal of actions in the IP’s head prior to action.

Sensorimotor Substage VI

Thinking before Action (18-24 months):  The primary achievements of this stage include the ability to rehearse actions mentally before acting, the ability to imitate actions seen or heard outside of the immediate present or place, and vastly increased ability to share ideas through symbolizations of [concrete] objects, actions, or events. This is why children typically experience a rapid expansion of receptive (understanding) and expressive (speaking) language at this stage of development.

Mental Rehearsal: Because the IP carried on so many “experiments” in the previous stage, he or she can now use some of the information learned previously to perform new acts without the random trial and error that dominated Stage V.  While trial and error means of learning exist throughout the life span, a child can now take advantage of imitation and mental rehearsal to make the process more efficient and systematic.  While children are still rather impulsive at this stage, this is more a feature of their emotional development than their cognitive development (although it is difficult to separate the two).  The IP truly functioning at Stage VI of cognitive reasoning can be seen thinking about actions shortly before taking them, choosing not to act in certain situations, making more deliberate moves, and performing two to three step actions on objects.  For example, the IP might see an object of desire she cannot reach.  Instead of simply reaching in vain, she might move a chair in place (action 1), stand on the chair (action 2), and then reach for the object (action 3).  In most cases this coordinated response is predicated on mentalizing the actions, in sequence, prior to acting).

Delayed Imitation: This refers to one’s ability to imitate actions witnessed hours or days before.  It is at this stage that we see children imitating actions they observed adults or other children doing at other times and places.  Typically, delayed imitation centers around familiar routines, but can also incorporate actions witnessed on television or videos – as long as there has been sufficient exposure.  As this skill becomes more a part of the developing person, and his or her other sensory, motor, and thinking skills have expanded further, less exposure is needed, and imitation is now open to increased variation on ideas and actions.

Symbolic Reasoning: Stage V is the stage where many children develop the ability to associate and even speak words they associate with concrete actions objects.  At that stage, they began to “label” objects (nouns), people (names such as Mama, Suzie, etc.), or simple actions (i.e. “up” “go”), but could not label activities (i.e. dinner).

Stage VI on the other hand is characterized by the emergence but not mastery of concepts, and the increased ability to represent objects, actions, events, or people with symbols such as dolls, figures, toy representations (trucks, pots and pans, play house, etc.), or through words and pictures. This means that communication can now take place about objects or ideas outside of the immediate setting, opening up a vast world of shared ideas to learn from.   Simple concepts are forming (i.e. the ‘concept’ that “dinner” involves eating, “toys” are objects to play with, etc.), but remain very fragmented, concrete, and unstable.  Towards the end of the stage, children become ready to understand concepts such as categories,  and are able to use this knowledge to match and sort objects that are simple in terms of their attributes (i.e. same shape, same color, etc.), but many children are not ready to do this until the next stage.

A very typical pattern of uneven development seen in children with Pervasive Developmental Disorders involves the development of skills in Stages V, VI, and beyond, built upon incomplete mastery of these and earlier stages.  For instance, the development of visual and spatial skills and object concepts can be characteristic of Stages V, VI, or beyond, but the skills that require imitation and coordination of intent and motor planning can remain characteristic of stages III, IV, and V.  For instance, it is not unusual for a child to be able to do puzzles, master shape sorters, or make simple constructions with objects, but have no interest in representations or sharing ideas with others.  Relatively complex skills can be mastered in terms of object manipulation, but the child can remain unable to learn from imitating, or does not exhibit fundamental learning skills such as eye-contact (which enables social and linguistic learning later on), attending to people, shifting attention or tracking important objects or events, or sharing attention with another to the same thing.  This can lead to limited and very perfunctory forms of communication such as hand-leading or reaching for objects – that do not require true sharing of ideas.  Some children, who have not mastered coordination of intent (moods, feelings, and desires) with skills of motor sequencing (performing component motor actions in sequence, e.g., reach, grasp, turn, then pull), can engage in repetitive actions much of the time, or when stressed.  Repetitive actions are characteristic of Stages III and IV, as described above.

The Preoperational Stages

Preoperations Stage I

Preoperational Phase (2 – 4 years):  Building on newly developed ability to store representations as mental symbols and to imitate behaviors without the model present, children expand their abilities from representing their ideas with actions – to representing their ideas internally, as mental symbols.  Thinking can now travel in time, from the past to the present and into the future. Because of this, the individual is no longer completely bound to the here and now.

In typical development, we see play that is based on imitation – something we call “symbolic play.” A defining characteristic of this type of play (and thinking) is the ability to use one object or action to represent something else. A twisting gesture of the hand represents opening a bottle. A broomstick can represent a horse. One can pretend to eat, sleep or do other actions – without props.

The advent of the tool of language vastly increases the power of thought. The third year of life is associated with a “language explosion,” where the child’s relatively marked gains in spoken vocabulary and grammar facilitate not only communication, but self-guiding. In other words, children begin to think in words and they use speech (overt and covert/private) to talk themselves through their actions. The ability to think in a stepwise manner – with language, facilitates multistep play.  Instead of simple towers, the child now makes real constructions of imagined objects (e.g., a house; a train track). The child does not just roll her car; she drives the car to school, goes to the classroom, and becomes the Teacher – organizing her dolls and playmates in her pretend classroom.  Initially, these scenarios are very loose and fragmented – and a bit unreal.  As the child develops the prerequisite visual/spatial and motor skills, constructions and play scenarios become more plausible and representative of reality.

Preoperations Stage II

Intuitive Phase (4-7 years): Very importantly, this stage marks the beginning of true social play.  Prior to this, the child’s play was almost entirely egocentric (as was his or her speech).  Before Preoperations Stage II, play is largely in parallel, where each child has his or her own agenda, but may observe and imitate the play of others. Increasingly, what the child sees becomes incorporated into his or her own play. Speech becomes more social and less egocentric.

Think of the mental feats that reciprocity requires. One has to be able to assess the meaning of other people’s actions and utterances rapidly enough to respond in real time. Responding means not only forming a motor plan, it may have to be a spontaneous one – as none of us can know completely what our partners will say or do. Our assessments and our responses include layers of non-verbal, verbal and mental symbols, and we differentiate our words and actions in subtle ways to express nuances of meaning. We have to be able to do this in an ongoing way. There’s little time and space to consider a partner’s input, nor is there much time to rehearse ones response.  The mind must also choose what should be overt in action, versus covert in thought – although in the middle of this stage (4 to 5 years old), thought and action are not completely independent of each other. Also, the child begins to grasp that his or her ideas are not the same as reality, although it is difficult for Kindergarten-aged children to be able to distinguish the two.

Towards the end of this stage, the child can have an intuitive grasp of logical concepts in some areas. However, there is still a tendency to focus attention on one aspect of an object while ignoring others (e.g., a ball rolls down a hill because it is heavy – or round).  Without the ability to conserve representations, the child can still be fooled by his or her perceptions.  Concepts formed are crude and irreversible.

One characteristic of this phase is attribution of human qualities and motivations to inanimate objects, something Piaget referred to as animism or animistic thinking. This is but one aspect of “magical thinking,” a type of logic associated with 4 to 7 year olds. Children might believe that rain happens when the sky cries. The sun goes to sleep.  These assumptions by intuition – uninformed and unimpeded by empirical evidence, gives the stage its name.

Magical thinking is a manifestation of the child’s egocentrism (see above).  Children believe that their parents only exist to take care of them – and may believe that their parents were born after them. This is why some children don’t want to take that final step in toilet independence – because becoming independent might mean that their parents would cease to exist.

When Piaget pointed out that adults may not enter formal operations, he was probably referring to superstitious and other forms of non-scientific thinking. Cultures believe that gods make things happen and calamity is due to angering the spirits.

Good parents and Teachers often exploit this magical quality of thinking.  They might say that the TV is tired, which is why it has to be turned off. The child that does not want to make a bowel movement outside his diaper may think that poop is a part of her body, so her Mom makes sure to wave “Bye-Bye” to it as she flushes.

The Concrete Operations Stage           

Period of Concrete Operations (7-12 years): This stage occurs in the elementary years and is marked by the advent of logical reasoning.  This is why similar periods in childhood are considered the “age of reason” in many cultures.

• Logical reasoning at the Concrete Operational level is concrete. This refers to forms of thinking that remain confined to the physical/tangible realm.  Thinking tends to be limited to evidence from one’s own personal experiences rather than from theoretical examples.  Children may have difficulty “abstracting” from the evidence principles that predict the outcomes of things (e.g., 5, 10, 15, 20, ___; a, c, e, g, ___)
• Logical reasoning at the Concrete Operational level is operational.  The term “operational” refers to the stepwise nature of thinking where one “operates on” information step-by-step.  Steps of thinking can go forwards and be reversed to approach problems from different ways.

New Equilibration of Memory: Conservation: The qualities of thinking that develop in this stage allow children to perform academic behaviors that require stepwise thinking forwards and backwards.  The ability to reverse thinking allows the child to “conserve” or “restore” qualities of objects to their original states. Now, instead of believing a quantity is somehow more because it has been made longer, taller, or spread-out (but without adding anything to it), the child can reverse the mental representation of the object to its original form. Piaget’s genius was to tie this new ability to academic operations. We can see that number symbols (numerals) and the amounts they represent can be used to understand and illustrate how they can be shifted around by reversing and regrouping them. Letters – as representations of sounds, can be combined and recombined to form different words. Sentences can be rephrased.

“Conservation” isn’t the only example of stepwise thinking. In fact, most developmental psychologists see this period as the advent of truly organized, logical forms of thought such as inductive and deductive reasoning. The child performs operations of thinking on the facts, and no longer makes up explanations or believes his or her own intuitions without question.

New Equilibration of Egocentrism: Children develop abilities to take another person’s perspective in the stage of Concrete Operations. Their behavior and communication reflect understanding of what others know and don’t know, based on observation of the interactive world. They no longer assume that everyone knows what they know and can take the informational needs of the listener into account when communicating.  Sharing of one’s experience can now take place in the symbolic realm – with words, pictures, etc. – rather than engaging in direct experiences together (e.g., telling stories, reminiscing; joking, etc.)

New Equilibration of Symbols: Children can transact ideas by manipulating symbols (e.g., reading and writing; arithmetic) rather than the material (e.g., sounds, amounts) they represent. Children at this age now learn in school from and with symbols for amounts, sounds, lengths, volumes, etc.  Children can now make use of information and solve problems purely by performing steps of thinking by processing symbols (written words; numerals). Thinking can occur in words alone or in visual analogies – as in matrices or arithmetic operations.

• In order to read, they must first interpret the meaning of the letter symbols as representative of sounds; string the sounds together and read them as words; take meaning from the words and create mental concepts of the ideas conveyed by the words, etc.
• Arithmetic operations require interpreting the symbols for amounts first – numerals, and then perform steps of thinking involved in addition, subtraction, multiplication and division and so forth.  Arithmetic operations typically introduced in the middle of this period require reversing, regrouping, finding differences and equivalences, etc.

There is a limit to the child’s ability to learn by decoding and encoding symbols. Symbols have to represent real things like sounds or amounts. A concrete operational child can be expected to have trouble considering dynamic symbols such as variables, which represent hypothetical amounts.

Inductive Reasoning is a form of logical reasoning that emerges at the Concrete Operational level in typical development – given reasonable exposure to this type of thinking in the environment.  Inductive reasoning takes something specific and applies it to a more general idea. Elementary aged children tend to take things that they see and apply it in a way that helps them understand patterns and trends of change in the environment. For example a child sees that girls like pink, therefore, he might conclude that all girls must like pink.

This makes evident one source of the black and white thinking also associated with concrete type thought.

• Corporations are people under the law
• General Motors is a corporation
• General Motors is a person?

Deductive Reasoning emerges later on. Deductive logic involves using a general principle to determine what the outcome will be of a specific event. For instance, if the general rule is that ‘fruits have seeds inside,’ it follows that if an example – say a tomato, has seeds inside, it must be a fruit.

An example of a deductive argument:

Fruits have seeds inside → Tomatoes have seeds inside → Therefore, tomatoes are fruits.

1. Premise 1: All fruits have the attribute “seeds inside”
2. Premise 2: Since tomatoes have seeds inside
3. Premise 3: Tomatoes are (must be) fruits

Classification: Children learn to group objects by common characteristics in the late Sensorimotor and throughout the Preoperational stages. Now, logical thinking extends the concept of categories to a new level of equilibration. Children can now understand that objects can belong to more than a single category…

A horse can belong to the following categories:

Animals
Mammals
Four-legged
Vegetarian
Large
Farm
Transportation

…and that categories can overlap:

Which is the larger amount: all of the horses or all of the animals?
If there were no mammals in the group, would there be horses in the group?
What does a horse have in common with planes, trains and automobiles?

Seriation: Given concrete objects to manipulate, concrete operational children can place objects in some type of serial order, a logical thinking ability Piaget termed “Seriation.” Seriation can be done concretely – with tangible, manipulative materials (e.g., straws of different lengths; balls of different sizes, etc.) or symbols of those materials (e.g., 5, 6, 7, 8…).

The concrete nature of equilibration at this stage may also lead to limitations at black and white thinking. Early on, children can be expected to have difficulty with rules that seem to conflict (e.g., Can my Mom be a daughter and a sister at the same time? Can a Mustang be a car and a horse? Why is a Zebra considered a horse?)

Period of Formal Operations (12 years and onwards)

During this period, thought becomes more abstract, incorporating the principles of formal logic.  People functioning at the level of formal operational thinking can advance and refine their concepts by reordering and reimagining ideas in their minds alone. They can talk about possibilities, and the recursive (nested) and recombinant (reordered) nature of thinking allows high levels of creativity. Thinking is no longer bound to the known or the limits of one’s own experience.  People can form hypotheses and conclusions based on using rules of thinking to imagine the currently unknown. Thinking is less tied to concrete reality.

New Equilibration of Memory: The formal operational thinker can think about his or her own thinking processes and states of knowledge. They can reflect on their thinking and on their abilities and they can compare their thinking and abilities to those of others. The ability to generate abstract propositions, multiple hypotheses and their possible outcomes is evident. From this foundation, people can go on to develop many different kinds of thinking processes, and even to invent new ones or adapt learned ones to novel situations.

The formal operational thinker is not limited to information available in the present or listed in memory. They remember rules for thinking and managing information instead. Whereas the formal operational thinker employs rules as tools for thinking, they do not confuse rules with absolute truths. Therefore, the formal operational thinker remembers exceptions and modifies their theories and their rules of thought (principles).

New Equilibration of Egocentrism: Can make informed and reasoned assumptions and estimates of other’s perspectives. The individual can engage in thought that considers other’s knowledge states and patterns of thought.

I don’t like strawberry. I like vanilla, but I like chocolate the best.
Is chocolate ice cream good? Is it the best?
Chocolate may be best but only to me. You might like strawberry the best. So what is best depends on your perspective.

New equilibrations of egocentrism emerge that includes the ability to consider multiple points of view and multiple possibilities therein. The ability to understand that the sun only appears to revolve around the other when in fact evidence shows it is the other way around requires perspective taking. The ability to understand why the horizon looks like it does or why the sky appears blue requires perspective taking.
Ever-increasing nuance in perspective-taking is relative to academic subjects such as history, social science and literature that examine the perspectives of the actors. New equilibrations in perspective-taking allow increasing depths, layers and varieties of inference and story/event prediction.

The ability to take multiple perspectives can lead to anxiety. This may explain some behaviors and attitudes commonly associated with young teens. The newly developed ability to imagine what others may be thinking can lead to errors of estimation. They might overestimate the perspectives of others and may believe that “everyone” is thinking about them, when in fact few others know or care. They might underestimate the perspectives of others and assume that others don’t know or care (e.g., adults) when in fact they do. Metacognition is evident in emergent concerns about social issues and their identity.

As teens develop abilities to examine different versions of the truth, they may question adult authority. Parents and Teachers and even government and religion may no longer be seen as sources of absolute truth.

New Equilibration of Symbols: Advances in symbolic thinking lead to dynamic applications of symbols such as mathematical variables and proofs used in formal logic or philosophy. Thinking itself can be symbolized and considered (metacognition). The wide array of ways that the mind has learned to represent reality can lead to internal rehearsal of different possibilities – so direct experimentation or manipulation of materials is not always necessary. The formal operational story teller can think of several ways to tell the story – including ways that reorder the sequence of events in unique ways. The formal operational chef has an intuitive sense of how novel combinations of spices might work. The formal operational musician may not need to have an instrument handy because he can “hear” the melodies in his head just by reading the musical notation in the score.

Hierarchy of Symbolic Understanding

The following is a suggested taxonomy of symbolic understanding, since there isn’t one published.  The hierarchy in the table comes from literature review and some rather sparse published hierarchies. I attempted to put the symbols in hierarchical order, but you can be assured that there is expert disagreement on the fine details (not the general order from index to symbol to sign).  There should also be considerable overlap between levels.

Consider the table below as a working model.  As with any of the other taxonomies given in this or other sections – it does not matter what stage we think the IP belongs in.  What matters is the behavior observed, and whether or not the behavior may be a function of insufficient conceptual understanding for the demands of the environment.  Hopefully, when the discrepancy is identified, the Analyst can use this table to inform the selection of replacement behaviors to teach.

Representation	Form
Index
	Responds to sensations
	Recognizes familiar interoceptive sensations (e.g.,   hunger; thirst; full bladder/bowel; being picked up)
	Recognizes familiar exteroceptive sensations (e.g., being   touched; fed; changed; being picked up)
	Discriminates/Shows preferences among proximal percepts   (recognizes smells, tastes, forms of touch; position)
	Able to recognize objects and actions that he or she has   seen before
	Able to remember the presence and absence of an object   (simple mental representation)
	Understands that a part of the object represents the whole   object (e.g., when object is partially hidden)
	Understands the meaning of a simple hand gesture (e.g., up;   hug; come here; sit here; stop)
	Understands that you cannot see him or her when you are   not present or your back is turned
	Understands the meanings of objects and actions in context   (responds differentially when he or she sees an object or action that someone   else is doing: e.g., responds when he or she sees parent take out pots and   pans, that a meal is being prepared; understands that backpacks are being   handed out that it is time to go home; understands when the parent goes to   the refrigerator that she is going to get the drink she requested)
	Understands the function of real objects
Receptive   Joint Attention	Understands/follows finger point, where finger touches the   object
Symbol	Understands the meaning of a symbolic gesture (e.g.,   pretends to drink with an empty cup;
	Recognizes the meaning of objects (realistic facsimiles;   miniatures with realistic features)
Receptive   Joint Attention	Understands/follows finger point from a distance
	Understands/follows head point
	Understands/follows eye point
	Recognizes the meaning of here/there; it/that, when   accompanied by pointing (deixis w/pointing)
	Spoken labels of objects/people regularly encountered
	Spoken labels of actions regularly encountered
	Color photos
	Black and white photos
	Line drawings
	Picture Symbols (e.g., PEC)
	Uses props that show only partial resemblance to real   things (uses blocks to make a house; can understand
	Spoken words that represent amounts (“Count five eggs.”)
Sign	Rebus
	Spoken labels of objects/people not regularly encountered
	Spoken labels of actions not regularly encountered
	Written words
	Numerals
Conservation
	Conservation of amount, length, weight, volume, etc.
	Reversibility
	Transduction
	Logical cause and effect
	Inductive Reasoning
	Deductive Reasoning
	Scale Models
	Maps
	Graphs
	Basic Arithmetic operations
Abstract Reasoning
	Testable cause and effect
	Metaphor/Simile
	Analog or analogous reasoning
	Recognizes the meaning of “variables”
	Uses formal logic and critical thinking (rubrics; proofs)

 

 

References

Bodrova, E., & Leong, D. (2005, October). High Quality Preschool Programs: What Would Vygotsky Say. Early Education and Development, 16(4).

Emde, R. (1989). The infant’s relationship experience: Developmental and affective aspects. In A. Sameroff, & R. Emde, in Relationship disturbances in early childhood: A developmental approach. Basic Books.

Garcia-Winner, M. (2007). Thinking About You, Thinking About Me. Think Social Publishing.

Greenspan, S. a. (2010). The Learning Tree; Overcoming Learning Disabilities from the Gound Up. Da Capo Press.

Greenspan, S., & Benderly, B. (1998). The Growth of the Mind: And the Endangered Origins of Intelligence. Da Capo.

Johnson, S., & Soska, K. (2008). Object Concept. Elsevier.

Koziol, L., & Budding, D. (2010). Subcortical Structures and Cognition: Implications for Neuropsychological Assessment. Springer.

Novak, G. P., & Palaez, M. P. (2004). Child and Adolescent Development: A Behavioral Systems Approach. Thousand Oaks, CA: Sage Publications.

Piaget, J. (1971). Genetic Epistemology. W.W. Norton .

Piaget, J., T., B., & Thampy, K. (1985). Equilibration of Cognitive Structures: The Central Problem of Intellectual Development. University of Chicago Press.

Publisher. (n.d.). What is Cognitive Semiotics. (P. Bundgaard, M. Donald, B. Galantucci, & G. Sonesson, Eds.) Journal of Cognitive Semiotics.

 

Forms of Memory

I happen to subscribe to the theory put forth by Joaquin Fuster,[1] that what we call “memory,” is actually the process of reactivating neural circuitry previously established through experience. In other words, it isn’t “storage” per se. The brain doesn’t store what it knows in some sort of storage area where “memories” are located. Memory is really a matter of re-experiencing or re-running ensembles of neurons that became established as circuits of by an experience in the outside or inside (mental) world. The circuit represents the experience in a physical way. What we experience as memory is really just the reactivation of established circuits.

“A memory is basically a network of neocortical neurons and the connections that link them. That network is formed by experience as a result of the concurrent activation of neural ensembles that represent diverse aspects of the internal and external environment and of motor action.” [2]

The parallel course of perception and action (motor planning) involves connections between neurons and the traveling and re-traveling of neural circuitry. Experience, taken in through the senses, activates neurons specialized to process forms of the information coming in through sensory reception. Each unique experience “recruits” neurons from the activated processes (each sensory reception ‘process’ [e.g. vision, audition, etc.] represents another assembly of neurons [“circuits” or “assemblies”] that perform specialized processing tasks). Unimodal and multimodal experience creates new neuronal assemblies.

A famous axiom in neuropsychology is, “neurons that fire together, wire together.” This means that an experience involves the firing of neurons in an ad hoc assembly or network. This newly linked network, if traveled enough, or if emotional centers of the brain assign it importance,[4] becomes more easily activated by any ‘node’ on the network.

So for instance, a person tries a new dessert and it is absolutely scrumptious. The dessert has an appearance (processed by visual components of the brain, or visual “processors” [that are also assemblies or circuits of neurons that developed earlier through prior experience in infancy]), a smell (olfactory processors), a taste (gustatory processors), weight and texture (proprioception processors), etc. And it also activates emotional processors (“Wow this is good”) where the emotional parts of brain assign value. The person experiences the dessert as a coherent, unified perceptual whole by associative processes that combine the information coming in from the senses into a temporally coherent and singular (but multifaceted) stimulus.

The ‘mental representation’ of the dessert is a newly formed network of neuronal processor circuitry forged through experience. The network has [potential] multiple entry points or nodes that once activated, re-activate the rest of the network. So for instance, seeing a picture of the dessert reminds the person of the feeling he or she had about it. Or perhaps if the smell of the dessert wafts in from another room, the sight of it, the feeling about it, perhaps how the dessert sounds when you stick a fork in it, etc. can re-experienced from the singular stimulus of the smell.[5] The re-experiencing is a re-collection of the neuronal assembly originally wired together from the original experience.

Recalling Changes Memory

Since memory is really re-experiencing and not some static form of storage, the very act of recalling the experience changes the “memory.” With the possible exception of “flashbulb memories,” recollection in the present automatically connects the original experience (the original neural network) to stimuli entering the senses from the present. For this reason, recalled “memories” are always inaccurate to some degree, but perfect accuracy of memory isn’t required for typical functioning.

Therefore, what we describe as memory is really more about the means of encoding and retrieval than the “storage” or retention. We all use the term ‘memory’ as a heuristic – a means of understanding neural assemblies wired in temporal coincidence and re-activated. The term facilitates discussion about the subject, if not scientifically specific enough accuracy. What is “retained” is ephemeral and dynamic.

Encoding of Memory

Encoding involves the process of changing existing neural assemblies or traveling new ones in Hebbian fashion. In the short term, this merely represents a temporary lowering of thresholds for activation of the new circuitry. In the case of longer term memory, the DNA of the neurons change, resulting in a change in the protein structure of the cell. This is a process called epigenesis. [6], [7]

It has to do with how information is converted from initial stimulation and sensation^[8] of the senses (registration or experience without awareness), the perception (awareness and conscious experience of the stimulus), and conception (the ability to understand the experience in cognitive terms).

Take color vision for instance. The light waves enter through the retina and eventually activate the visual cortices.

Now let us compare two people, one who is color-blind and another who is not. Both register the color in their retinas and optic nerves (the sensation or initial registration of the stimulus). But the color-blind person has trouble with the perception, or the mental interpretation of the stimulus, which makes it impossible for him to tell the difference between green and red (minimal contrast). Both of these people, being otherwise normal, know that red and green are “colors” (a concept) and that things sharing the same color features are called “red” (the concept of ‘red,’ or, as they say in neuroscience “the concept of redness.”).

We can think of encoding as an input process, although there is no pure input or output process in the brain. That is because the brain engages in active processes to attend, receive, interpret, and if applicable, wire up new networks (form “memories”) in order to process the information. Therefore, the seemingly passive process of perceiving is passive by no means.

Memory Retrieval

Retrieval is what most people think of as “memory.” It has to do with how neural circuits are reactivated as a result of internal or external triggers. There are two primary categories of retrieval: “explicit” and “implicit.”

Explicit Memory

Explicit memory is often called “declarative memory” and refers to “…memories (or representations) that can be declared, can be brought to mind, exist in some time frame, are characterized by recognition or recall of past experiences, and for which we are consciously aware of the encoding or retrieval.” [9]

While many do, I do not consider explicit memory and declarative memory as completely synonymous. That is because explicit memory deals with static facts and knowledge (e.g. the square root of 9; the day Lincoln was shot; your name and birthday, etc., all of which represent unchanging data), as well as with personal (autobiographical) memories of episodes, which involve subjective and dynamic appraisal (perspective) of events.

Forms of Explicit Memory

Declarative Memory

This has to do with any form of memory that can be consciously called to mind and therefore declared. Awareness is its defining feature, which is why many do not make a distinction between declarative and explicit forms of memory. In the following paragraphs, I will make this distinction:

Semantic Memory

This has to do with non-subjective forms of information. Semantic memories involve the remembering of facts, details, order or sequence, steps in a process, etc. (e.g., Lincoln was the 16^th President of the U.S.; lunch follows recess; 2 + 2 = 4; the recipe for chicken soup; the address of my house; the definition of words, etc.).

Semantic memory has mainly to do with static features of the environment. These stimuli do not change and do not involve the perception of change.

The word “semantic” implies understanding of meaning. But we have to be careful here. We are not talking about the subjective or personally defined meaning here. We are talking instead about objective meaning, as in dictionary definitions, descriptions of cause and effect (“more labor means more cost”) and the like.

Not surprisingly, people with autism usually show strength in this more or less unemotional form of memory. Since things like lists, maps, answers to factual questions, mands (demands, commands, remands and reprimands, etc. and the correct v. incorrect responses these forms involve) are static forms of information and communication, many with ASD show relative strength in these forms of reasoning. ABA teaching focuses mainly on semantic forms of memory.

Finally, declarative memory is not the same thing as declarative language, although declarative language can be used to describe declarative memories. As described in the link, declarative language has to do with voluntary sharing of experience (the language of open systems), as opposed to the instrumental use of language, which is the language of static (or closed) systems.

Episodic Memory

Episodic memory involves remembering the factual aspects of events and/or the personal and subjective experience of the event. Endel Tulving is generally considered the foremost expert on the subject and the father of the idea, although now there is a fairly robust body of research on the subject not only in neuroscience, but also in the field of Artificial Intelligence). Tulving describes two forms of autobiographical memory (memory of events that a person experiences):

Autonoetic Memory

Autonoetic of remembering involves the re-experiencing (reliving) of an event, implying reactivation of sensory experiences from the past. This involves traveling backward mentally in time. I can tell you not only that I experienced the event (noetic), but what I thought and felt, what was relevant or not, what other people thought or intended according to me, etc. Autonoetic memories comprise the bulk of social experience-sharing.

Noetic Memory

Noetic remembering in contrast, consciously draws on personal knowledge, but does not “relive” the past or “travel backwards in time.”[10] For instance, I can tell you that I ordered a pizza the other day, but my memory is just a thumbnail representation of the event. I can tell you that I did it and that I was successful, but I can hardly relive it.

People with autism tend to rely mainly on noetic memories and have very weak autonoetic memory. For instance, if you ask a child with ASD what he did at school, many will report what they did (“I played on the swing;” “I ate corn dogs for lunch”), with little or nothing in terms of elaboration of their subjective appraisal of the events (“My new friend Johnny was there too” “I like the swings but I’m getting sick of corn dogs”).

Memory of the Future or “Mental Time Travel”

Our ability to anticipate and plan is predicated on autobiographical memory. In his essay “Memory of the Future,” neuroscientist David Ingvar refers the idea that our anticipation of the future is based on information from the past, which we “project” into imagined future events for the purposes of planning responses.[11] The process is in large part visual for us, probably because we are primates. That is why the most common term we use is “imagination” because we use internal visual imagery in our minds to anticipate future events. Importantly, the imagery we use for this process consists of not only the scenery but the actions we plan to make – whether that be the very next step in an immediate temporal sequence or long term into the future. Memory of the future utilizes mental representations established in the past, and consists of these existing representations as they are transported mentally into the future.

Imagine going to the grocery store tonight to pick up a carton of milk. Guaranteed, your mental representation of this future event consists of visual imagery from some grocery store you have been to the past, or some amalgam of different grocery stores you’ve been to or have seen. Your actions: getting a carton of milk, recruit representations that were established previously from your prior actions.

Now when you physically go to the store, the actual experience will be more or less congruent with your anticipation (or the collection of representations from your past). You could show up and find that the store burned down, which would be incongruent with your projections.

Projection also involves a trajectory of change. If I were to imagine my future, I would have to base my anticipations on trends of action that I have observed so far (noted through my tracking of change and its direction), intentions, and other possible influences, causes and effects and the like – all emanating from my experience in the past.

Implicit memory

Implicit memory comprises forms of memory “for which the subject does not need to recall the specific learning episode and may have no conscious awareness of, or may perform in an unconscious manner; those that are procedural; and those that involve rigid and inflexible representations and responses.” [12]

Phyletic Memory or “Phylogenetic Memory”

This is commonly referred to as the “memory of the species” and comprises perceptual and motor skills that are largely inborn. The best example would be reflexes, which are carried out by the spinal cord and brain stem. Phyletic memory is modifiable to a very limited extent (we can keep from blinking for a while or train ourselves to control certain reflexes).

Importantly, [neurotypical] infants are born with a bias towards faces and the ability to respond to attachment behaviors and emotion signals specific to our species. The form these behaviors take over the course of development has much to do with environmental and cultural learning, but the capacity to learn them is innate. One can hug and kiss a snake all she wants, but it will not result in attachment behavior in the snake.

Perceptual Memory

Perceptual memory has to do with the establishment of neural circuits from basic input to the senses (from external, interoception, and kinesthetic/haptic stimuli). This allows re-cognition of the stimulus the next time the animal experiences it or something that shares common perceptual features. This does not require consciousness or awareness, but is always involved in more declarative processes.

Motor Memory

Motor memory “…consists of representations of motor action in all its forms, from skeletal movement to the spoken language. It too is acquired and evoked through the senses but, once acquired, it is largely represented in the neocortex of the frontal lobe, which comprises roughly one third of the human neocortex. The most automatic and firmly established aspects of motor memory are represented outside the neocortex, notably in the basal ganglia and the cerebellum.” [13]

Fuster describes a motor memory process where new skills require the activation of higher processing centers in the neocortex, and then, with repeated practice or overlearning, the same skills acquired through more assiduous processes become under the control of lower structures such as the brainstem and cerebellum. Once this happens, subconscious processes, the behaviors tend to be executed automatically (or for a lot of behaviors, without awareness – such as when we shift our attention constantly in social dynamic interaction). We commonly refer to this as “second nature.”

“Even motor programs in primary areas seem to migrate to lower levels after acquisition and practice. Following lesion of the somatosensory cortex does not abolish the skill. Thus, corticocortical projections from somatosensory to motor cortex play a critical role in the learning of new skills but not in the execution of existing ones. Presumably, this is the case because the latter have become automatized and relegated to lower structures of the motor hierarchy. …this phenomenon was first described by Jackson[14] in 1866. [These] observations suggest the migration of motor programs from higher cortex toward lower cortical or subcortical levels as their execution becomes established.”

“…as we make our way down from prefrontal cortex to motor cortex, neuronal networks generally appear to represent motor actions that are progressively less voluntary and more automatic (i.e., stimulus-bound), less abstract and more concrete in both space and time, less new and more firmly established in the experience of the organism or the species.” [15]

This is an extremely important concept necessary to understand autism. Observations of people with autism reveal that they tend to monitor their own actions long after the brain would be expected to migrate the skills towards subconscious control. This explicit attention leads to the self-absorption associated with the disorder. Subsequently, the assiduous monitoring of one’s own actions takes attention and other mental resources away from tracking the environment and tracking change. This further implies that there is a corresponding lack of epigenetic change in the neural networks responsible for executing specific skills or behaviors.

Procedural Memory

The name implies ‘memory of or for procedures,’ (as it is in cognitive science), but such knowledge can also be put into words (knowledge). Neuroscience describes it as knowledge or memory that is not easily put into words, such as the experience of balance or riding a bike. That is, the muscle contractions devoted to actions are perceivable but not easily described declaratively.

Procedural memories involve the ability to re-activate action sequences (or thought sequences – see my page: The Concept of Motor Planning). It encompasses perceptual and motor memory as it is acquired in the context of parallel perception-action cycles, and the memories are executed as perception-action cycles.

Repeated execution of a skill, idea, or action sequence (all the same thing) typically results in acquired procedural memories. Once acquired, they tend to be relatively resistant to change.

“With extensive overtraining… supplementary motor area activation disappears. …As we make our way down from prefrontal cortex to motor cortex, neuronal networks generally appear to represent motor actions that are progressively less voluntary and more automatic (i.e., stimulus-bound), less abstract and more concrete in both space and time, less new and more firmly established in the experience of the organism or the species.”[16]

The reader may wonder why I say that people with autism have difficulty moving acquired skills down the motor process hierarchy to basal and cerebellar control. After all, Fuster’s description of stereotyped and stimulus-bound behavior fits observations of autistic-like behavior, but that is superficial. Unless the actions are ballistic, as in Tourette’s Syndrome, these behaviors have specific functions, usually for emotion-regulation, social interactive purposes, or environmental defense (blocking out; fear-based rigidity or circular). Tellingly, most “self-stimulatory” behaviors stop whenever the individual focuses explicit attention on a changing stimulus. And finally, while it is true that circular behaviors represent the ultimate in repeated practice and become neurodynamic attractor states, they still seem to absorb the person to the extent that they cannot attend to anything else – implying that too much of the neocortex is still involved.

[1] Fuster, Joaquin, M.; 199; Memory in the Cerebral Cortex: An Empirical Approach to Neural Networks in the Human and Nonhuman Primate: MIT Press

[2] Ibid.

[3] This is a paraphrase of a statement in his book, “The Organization of Behavior” (1949; John Wiley & Sons), is as follows: “When an axon of cell A is near enough to excite cell B and repeatedly or persistently takes part in firing it, some growth process or metabolic change takes place in one or both cells such that A’s efficiency, as one of the cells firing B, is increased.” The phrase “neurons that fire together, wire together,” repeated often in neuropsychological papers is a paraphrasing of Hebb’s original statement and is commonly referred to as “Hebb’s Law.”

[4] Limbic centers of the brain (mainly the amygdalae), add their own [neurochemical] contribution to the experience to insure that the circuit is more easily fired (by chemically lowering the threshold for firing). These centers have through evolution become sensitive to a stimulus’ survival value.

”Survival value” or emotional significance is the result of a combination of inborn, genetically inherent “values” (valences) obtained through phyletic memory, as well as cultural/environmental shaping, where emotion systems develop new valences based on prior experience with the stimulus or with stimuli sharing common features.

[5] Humans have difficulty fully re-experiencing smells, tastes, tactile and proprioceptive sensations, but they can more easily re-experiencing what they saw, heard, or felt inside. It is interesting to note that olfaction, gestation, and tactition are “proximal” senses in that they either require actual physical contact with the stimulus, or close range stimulation. Vision and hearing on the other hand are distal senses in that stimuli can activate these senses from a distance. People can re-experience interoceptive or somatosensory stimuli since emotion processors are activated by (neurally networked to) every experience.

[6] This and some of the following links are to Wikipedia, the online, editable encyclopedia. I have checked these definitions out, as all entries into Wikipedia come from contributions from the public (usually experts in the case of science entries). These particular articles are quite good, at least at the time when I linked this file to the entries. They provide useful elaboration for this article.

[7] For an in-depth account of encoding processes, I refer you to Nobel prize winning neuroscientist Eric Kandel’s “In Search of Memory: The Emergence of a New Science of Mind” (W.W. Norton; 2007)

[8] Reflexes illustrate registration without awareness or ‘simple sensation.’ Reptile brains exist mainly on this level. The animal is not “aware” in the sense that there is any ability to appraise stimuli and respond flexibly. Sure, a reptile is capable of responding differentially to food v. non-food for instance, but this process is merely the activation of a phyletically derived action pattern. The animal has little or no ability to respond flexibly – which is a sign that evaluation is a more or less one-dimensional, automated and stereotyped stimulus-response relationship.

[9] Webb, S.J.; 2007; in “Human Behavior, Learning, and the Developing Brain: Typical Development;” Coch, D., Fischer, K., Dawson, G., Eds.; Guilford Press. Italics mine.

Interestingly, the chapter was funded by Cure Autism Now and the National Institute of Mental Health Studies to Advance Autism Research and Treatment.

[10] Tulving, E. (1983). Elements of episodic memory. New York: Oxford University Press.

[11] Ingvar DH. “Memory of the future”: An essay on the temporal organization of conscious awareness. Human Neurobiology. 1985;4:127–136

Also:

Spreng, N., Levine, B.; 2006; The temporal distribution of past and future autobiographical; Memory and Cognition; 34(8): 1644–1651.

Williams JMG, Ellis NC, Tyers C, Healy H, Rose G, Macleod AK.; 1996; The specificity of autobiographical memory and imageability of the future. Memory & Cognition: pp. 116–125.

[12] Webb, S.J.; 2007; in “Human Behavior, Learning, and the Developing Brain: Typical Development;” Coch, D., Fischer, K., Dawson, G., Eds.; Guilford Press. Italics mine.

[13] Fuster, J. 1999

[14] Jackson, J.H.; 1958; Selected Writings: New York: Basic Books

[15] Fuster, J. 1999

[16] Fuster, J. 1999

Using Piaget’s Epistemology of [Physical] Object Concepts to Analyze Social Behavior

In this example, we apply Piaget’s taxonomy of physical object concepts as they apply to the individual’s concepts of and behaviors with social objects, noting that the forms of behavior might be differen than those used with pysical objects.

Example: We often encounter individuals that behave in ways that they know are annoying to others.  They get hostile feedback and stops signs and commands to stop – even threat or punishment to get them to stop.  We might have difficulty wrapping our minds around what is reinforcing this behavior – why the hostile feedback we see them getting somehow encourages them to do it more?

Now if we look at an early stage of object thinking, Piaget’s Sensorimotor Substage V, especially the earliest parts of the stage –we see a great deal of experimentation with simple forms of trial and error and cause and effect.  That is, at or around the age of 12 months, infants move on from exploring just the sensory qualities of objects by touching and mouthing to exploring the effects of their behavior on objects.  They become fascinated with simple causes and effects.  They use [at first] random forms of trial and error to form concepts about what objects are made of and how they work.  The infant enjoys pushing things over, knocking things down, throwing, dumping, pushing things off the table, putting things inside other things and taking them out and push-button toys.  The goal of exploration apparently is experimental and exploratory – to find out “what if…”

The “what if” of human interaction, that is, the process of exploration and discovery of ‘what if I do this or that to this person or that person or the dog or any other animate creature in the environment..,” starts earlier in life.  The infant discovers that his or her own cries and sounds and movements and produce responses that can be anticipated.  We know that a good deal of our functional neurological resources are ready sooner after birth than others and ready to be devoted to developing social and emotional intelligence very early in life.  This is a species-specific trait among higher primates and especially so in humans.

By the time infants are ready to use their arms and hands and fingers to explore objects in the way they want, they already have a great deal of experience with behavioral and emotional cause and effect.  That is, the infant typically has, through social interaction and discovery, already developed theories of how a behavior (smile) seems to produce consequences of smiling in others.  By a year of age, the infant’s concepts of how people work are quite a bit ahead of their concepts of how physical, inanimate objects work.

In typical development, we see young children using their social intelligence to understand objects: they name inanimate things and otherwise anthropomorphize objects in play.   Also in typical development, we see relative divergence and variations in the balance of social curiosity and exploration, with some children placing more emphasis on developing their social intelligence (how people work), and others will spend more time developing their object skills).

Our Annoying 6th Grader

So let’s say in this case we are talking about an 11 year old 6^th grader that seems to be able to do well in most academic subjects, but experiences repeated social failure with peers.  The 6^th grade social milieu typically requires reading many signals at once along with language comprehension.  We are aware of significant deficits in social cognitive reasoning in this child – but this still does not explain why he repeats behaviors with peers that produce hostile reactions from peers.  There had been many times where if it wasn’t for the presence of an adult nearby, his peers might have escalated their hostility to physical levels.  And, he has been resistant to using the prosocial replacement skills that he’s demonstrated ability to do.

But if look at the social cognitive means or tools our 6^th grader comes equipped with as he endeavors to join the complex social interactions of other 6^th graders, we see that his social cognitive thinking is characteristic of early Stage V object concept behavior.

That is, we find that what reinforces this behavior is how reliable it is.  His annoying actions produce predictable effects.  The motivation for this behavior for this boy is being able to predict the consequences.  So in effect, he is “pushing buttons,” as if he is operating animated push-button toys.  He pushes the other person’s emotional buttons (and he has been experimenting with what works and what doesn’t and what works really, really well and what works less well), and they do their thing.

The consequences have what they call in mathematics “absolute value.”  +10 and -10 have the same absolute value of 10.  Due to his deficits in social concepts, our 6^th grader may not be able to discriminate the positive or negative valence of other people’s responses.  He can only discriminate how intense they are.  The intensity provides and absolute value.  It is higher or lower.  Our 6^th grader does not have the mental tools necessary to make other, more complex and subtle social behaviors of others meaningful.

Therefore, he appears motivated to turn on only the high intensity behaviors because hostile yelling and screaming sounds the same to him as excited and joyful behaviors.  In other words, whether the intensity of the response comes from extreme joy and happiness (positive valence), or irritation and rage (negative valence) they both share the same intensity and therefore have the same absolute [reinforcing] value.

The problem with his resisting replacement behaviors was the analyst’s assumption that social interactions are all of the same quality.  In this case, what this person enjoys is problematic.  He enjoys the intensive quality that comes from setting others off.  Anything less is not satisfying.  In fact, the analyst might find that there is little in the present environment that can produce similar consequences.  The so-called replacement behaviors never produce such exciting consequences.  Consequences of lesser intensity – because of this individual’s “push-button” appreciation of the social world, are not reinforcing.

There are many possible ways to address this problem, but that is not the point here.  The point is that we have a child that may, in certain academic areas be able to engage in relatively complex thinking, but the means he uses to explore and learn from social objects (people) are insufficient.  Mere exposure to peers will not result in beneficial learning because of the width of the discrepancy between himself and the social stages of thinking of in which his peers operate.  Including an examination of cognitive means, was useful here in our process of baseline logic, informing our hypotheses about the behavior in important ways.

Ballistic motor plans are rigid sequences of thoughts and behaviors that once set in motion resist feedback and therefore resist co-regulation while in progress.

Ballistic motor plans are behavioral states that represent indivisible wholes, where the parts (steps) are resistant to interruption, modification or re-ordering…

Steps are often “chunked” together neurologically, which is why the behavior seems so rigidly sequenced.  An analog to this is how a musician must learn to operate her right and left hands independently of each other to play the piano.  When starting, the beginning pianists’ hands are rather yoked together – but as she gets better at the piano, she can learn to operate her left and right hands in relative independence.  The system of pianist and piano began as stereotyped, ballistic and overly or indivisibly “whole” actions, but, as what happens lawfully in all systems – it moved towards greater levels of differentiation and complexity.

Once a ballistic motor plan is launched, the individual’s brain and body focus almost all of its energy on “output” and there is at the same time a marked failure to uptake information while the sequence of thoughts and actions is already in motion. Actions and behavior lose their connection and responsiveness to context, and cognition is no longer “situated.”

In other words, once the individual forms and embarks on a certain train of thought (ideas and actions), it somehow becomes a “freight train of thought:” difficult and perhaps disastrous to interrupt.   Indeed, the behavior is often described as “like a freight train,” “like a tape that has to run all the way to the end,” “running through all of the stop signs…”

Attempts to interrupt by gaining the attention of the individual and trying to get them to pay attention to something important in the “here and now” – to look or to listen, to take in information; to notice and deal with changes, etc. can lead to hostile reactions.  Hostile reactions can range from expressions of annoyance to rage.

As mentioned, ballistic motor plans are chunks of behavior or inseparable sequences of behavior emitted as a whole and they appear to come from long term rather than short term memory or immediate perception.  The marked lack of responsiveness to the environment leads is the result of the disproportionate energy the brain appears to expend on fulfilling the motor plan.  This is at a cost to environmental/contextual evaluation – specifically, the noticing and tracking of changes going on in the environment.  This further reduces the potential for flexible thinking and management of novelty and uncertainty.

The modern human brain evolved primarily to be a regulator of social survival.   Social thinking is the most complex operation the brain does.

This is a legacy of our primate history, although the human brain’s evolution goes back much further to mammal brains and mammal psychology.  We nurture our young as mammals do, and before the leap forward to the modern human brain, humans had already inherited the four F’s of mammal behavior: fighting, feeding/foraging, fleeing, and mating.

The main difference between the human mind (besides volume and the number of neurons) and other relatively sophisticated, social animals is the level of integration required for normal function.  The brain is a meta-system comprised of a collection of hundreds of thousands of individual circuits that perform specific functions.  Subsystems form mega-systems such as vision or hearing for instance, although each circuit depends on information and feedback from other circuits in order to do their job of processing information.

These circuits each evolved separately in order to solve some sort of environmental adaptation.  Because these circuits evolved separately and across millions of years, they process information in different ways using different means of encoding and outputting information, and very importantly – they operate at different speeds.  Because the modern human brain is a collection of so many circuits, central organizing systems also evolved that operate as switchboards that connect and synchronize the global system.

These synchronizers also underwent considerable evolution.  Genetically, they’re built to certain “expected” ranges of operation that are part of its biological evolutionary history.  That is, they evolved by calibrating to previously evolved codes and speeds of operation.  Therefore, when everything is within a certain normal range, individual processors can plug in to the rest of the system without causing a bottleneck or a disorganizing phase shift between systems.  In humans, there are four primary organizing systems: the hypothalamus/pituitary system (our legacy from simple organisms); the brain stem/basal ganglia system (our legacy from reptiles); the thalamic/limbic system (the “emotional brain” – our legacy from mammals), and; our extensive prefrontal system (what makes us capable of human capacities of planning and forethought, and behavioral inhibition).

The exclusively human prefrontal system only begins to “come on line” around the ages of 18 to 24 months, and does not fully mature into the 3^rd decade.  Before that, the brainstem has the primary job of neuroregulation, and then the thalamic system takes over.[1]  Each one has to stabilize, integrate, and synchronize with the others.  If this does not occur properly, whether due to the globally disorganizing effects of faulty individual processors, or impaired mega-processors such as the basal ganglia, cerebellum, thalamus, or prefrontal cortices – the result is a neuroregulatory disorder.  Neuroregulatory disorders are primary antecedent conditions to behavioral disorders.

Developmental disorders are forms of neuroregulatory disorders.  For instance, when the developmentally necessary connections are made to form the hypothalamic/pituitary system go awry, problems with basic “rhythmicity” can occur – that is, there could be difficulties with regulation of body systems (hunger, thirst, somatosensory perception on the subconscious level), mood and anxiety regulation and; arousal and alertness.

When brainstem, basal ganglia, and cerebellar systems lack integration – distortions of sensory perception and motor output typically occur, and the Student might forever experience disturbing sensory perception distortions, and difficulties regulating mood, attention, and motor activity.  Recent research into autism shows that early on, these children experience some sort of motor coordination dysfunction.

Later on, the emotional systems of the thalamus take on a primary role of regulating the rest of the brain’s subsystems.  This system mega-system plays a large role in coordinating and synchronizing other mega-systems that perform the jobs of somatic-sensory perception, and motor output.

Let’s say that one of the mega-systems, hearing or auditory processing is not developing normally.  It takes much too long (really on the order of milliseconds or seconds) for this processor to do its job.  The thalamus then might have great difficulty creating a unified perceptual experience of what the Student sees and hears, causing a disturbing phase-shift (remember the old Bruce Lee movies where the sound didn’t exactly match the visuals) in perception.  This is annoying at the least, and can cause a Student to ignore information from one processor in order to understand the other.  This in turn further distorts the meta-system as the mega-system that is habitually shut off is deprived of the environmental experience it requires to mature (calibrate).  The result is also developmental disorder.

Autism is one of the most severe developmental disorders, but in structure – it varies from other disorders such as learning disabilities, Tourette’s Syndrome, Obsessive Compulsive and other psychiatric disorders, and individual processing disorders such as attention deficits – mainly by the degree and type of neural dyssynchrony.  Interestingly, attachment disorders, which result from deprivation and disturbance of early empathic care, and of the related disruptive behavior, conduct, and personality disorders that are associated with a pathogenic environment, also lead to neural dyssynchrony and similar symptoms.

What Autism really represents is a severe neural integration disorder that makes the most sophisticated operation of the brain – social co-regulation, extremely difficult.

Brain Review:

• The modern human brain evolved primarily to be a regulator of social survival.   Social thinking is the most complex operation the brain does.
• The main difference between the human mind (besides volume and the number of neurons) and other relatively sophisticated, social animals is the level of integration required for normal function.
• There are four primary meta-systems making up the global meta-system of the mind: the hypothalamus/pituitary system; the lower part of the brain (brain stem, basal ganglia, and cerebellum); the central part (the thalamus/limbic system), and the prefrontal (executive) meta-systems.
• Meta-systems coordinate and synchronize mega-systems of sensory processing and motor output.  Each of these mega-systems consists of hundreds of thousands of individual circuits or subsystems.
• System dyssynchrony is the prime reason for neuroregulatory and developmental disorders.  It differs from other developmental disorders mainly by degree of dyssynchrony.

---

Brain Review:

 

·         The modern human brain evolved primarily to be a regulator of social survival.   Social thinking is the most complex operation the brain does.

 

·         The main difference between the human mind (besides volume and the number of neurons) and other relatively sophisticated, social animals is the level of integration required for normal function. 

 

·         There are four primary meta-systems making up the global meta-system of the mind: the hypothalamus/pituitary system; the lower part of the brain (brain stem, basal ganglia, and cerebellum); the central part (the thalamus/limbic system), and the prefrontal (executive) meta-systems.

 

·         Meta-systems coordinate and synchronize mega-systems of sensory processing and motor output.  Each of these mega-systems consists of hundreds of thousands of individual circuits or subsystems.

 

·         System dyssynchrony is the prime reason for neuroregulatory and developmental disorders.  It differs from other developmental disorders mainly by degree of dyssynchrony.

Therapist/Early Intervention Specialist Job Description

• Implement Treatment Plans: The Early Intervention Therapist works directly with children with special needs according to treatment plans and specifications provided by senior SCS Personnel and Clinical Case Supervisors.  The Therapist attends clinics and treatment meetings where he or she provides input into the development of treatment plans.
• Track Progress: The Early Intervention Therapist keeps clinic notes and uses behavioral tracking forms to monitor progress.
• Coach Parents: The Early Intervention Therapist coaches parents in the implementation of treatment plans.  He or she also keeps track of parents’ progress on parent education goals.
• Provide Clinical Feedback to the Treatment Team: Therapists meet with the Clinical Case Supervisor and/or Psychologist twice monthly to provide feedback on treatment progress and needs
  
• Parent Education: Help Parents and/or professional staff such as Teachers and Paraeducators (Stakeholders) understand the behaviors of concern in the contexts of their environments and the child/Student’s development and relationship capacities
• Collaborate with Stakeholders in developing appropriate responses and teaching techniques; ability to use Active Listening techniques and to build a trusting and respectful relationship with parents
• Help Stakeholders learn systems for understanding their child or Student’s behavior and development so that they can do so on their own after brief treatment is completed
• Demonstrate techniques if necessary (the emphasis is mainly on Stakeholder Coaching however, rather than treating behavior directly)
• Assess and Monitor progress of behavior and teach Stakeholders how to do it
• Complete Quarterly Reports of Progress and Recommendations

Qualifications

• Bachelor’s Degree (minimum) in Behavioral Science, Psychology, Education, Child Development or related fields; Master’s Degree preferred and/or
• One year (minimum) experience with the implementation of behavioral (ABA) or Relationship-based ABA (RDI; DIR/Floortime) treatment plans
• Personal experience as a parent of a child with Special Needs
• Proficiency in at least one of the major evidence-based ABA or Relationship-Based techniques; ability to explain basic principles and describe/implement basic techniques with children
• Prefer extensive knowledge of child development and parenting

© David Sponder, L.E.P., BCBA, DIR/Floortime Certified C2
Executive Director, Sponderworks Childrens’ Services

Criticism of the Current State of the Field and the Advice Given to Parents

There is a lot of confusion among parents regarding selection of a program that is right for their family, especially when they are told that ABA is the only research proven method for intervention.  First of all, it’s misleading and it points up a problem with how self-referenced the field of ABA can be.  The Journal of Applied Behavior Analysis (JABA), the Journal of the Experimental Analysis of Behavior (JAEB) and other journals published by behavior analysts tend to lack references to sciences that provide the theoretical and research support for the use of developmental, relationship-based methods or any methods referencing typical development (developmental psychopathology based) or; neurodevelopmental methods.

The field of ABA could be more of an open system, and there is increasing evidence that it is indeed becoming more open to the similarities and complements of other methods and theories.  But it has a long way to go, guidelines currently in use have had a stagnating effect on innovation and the average parent is unlikely to meet an unbiased, widely experienced person (i.e. in more than one method or system of intervention).  The field as a whole is much too dismissive of other theories of behavior and intervention.  Subsequently there is an embarrassing and appalling lack of understanding of natural childhood development (especially emotional development) used in the behavioral treatment of developmental disorders.  We endorse the basic principle of Developmental Psychopathology: that to understand abnormal development and behavior, one must first understand normal development.  We also believe in Edward O. Wilson’s (who pioneered the field of Social Biology) ideal of “conscilience” among scientific disciplines.  Essentially, conscilience occurs when various and seemingly unrelated fields (e.g. systems theory and behavior; genetics and behavior, etc.) find common underlying truths.

As a result, the current state of the field of FAB is remarkably uncsonscilient with other fields outside of behaviorism, therefore, it is fair to ask how much a professional knows about what he or she appears to reject.  (For an excellent critique along these lines, I refer you to “Shortcomings of Functional Behavioral Assessment; Functional Behavioral Assessment: Deeper Understanding of Behavioral Handicaps or Trojan Horse? by John Stewart, NCSP)

Here again, I cite the Autism Society of America’s policy on treatment options:

Our prescription based approach is meant to deal with the problem of no single program fulfilling every need, but it takes a whole lot of extra effort to develop expertise in both behavioral and developmental methods and few people do it.  People can advise you about what they know, but unless they have really studied and implemented a program, they have no basis for advising you against it.  Ironically, newer forms of ABAsuch as pivotal response therapy feature principles and methods developed and tested long ago by Developmentalists, such as following a child’s lead and developing pivotal responses.  And in the most cited research articles and books about the newer methods, there are few if any references to the developmental literature or researchers that first tested the methods.

What is a Functional Analysis of Behavior

The whole debate becomes a little ridiculous when you take a closer look at the guiding principles of ABA.  This is because any therapy that uses interaction and modification of the environment to promote developmental change or behavioral improvement can be analyzed functionally, and can be shown to follow ABA principles if the program is well designed and understood by the interventionist.  Below, I will offer a Functional Analysis of interaction principles used in the various methodologies.  But first, it would be helpful to understand what a Functional Assessment/Analysis of Behavior (FAB) is.  I will try to keep this non-technical.

The primary purpose, and therefore, one of the optimal outcomes of a FAB is the determination of the motivation of a specific behavior or class of behaviors (different forms of behavior that are similar in their relationship to the motivation).  These motivations are called “functions of behavior,” the meat of functional analysis.  At SCS, we further analyze functions in terms of ‘functions of’ (unintended or indirect results of behavior: such as losing friends), and ‘functions for’ (behaviors that can be considered intentional – even if it is undesirable).

Prior to developing a hypothesis about the reasons behind a behavior, one must observe and define in measurable terms what that behavior actually is.  For instance, it is easy to observe and measure the number of times a child leaves his seat or completes work or says a 3 word sentence.  But describing a behavior as a “bad attitude” or “angry behaviors” can be a source of confusion among different observers, and failure in intervention.  The important thing in this defining or “operationalizing” a behavior is that once defined, different observers can agree that they are measuring the same phenomenon.  This is called, “inter-observer agreement,” which provides the test of how well the behavior has been defined.

Since no one can ever determine with complete accuracy what motivation seems to be operating at any given time, the determination will always remain a “hypothesis of the function of the behavior.”  Hypotheses will always range from less to more accurate, so it is vital to consider as many forms of relevant information as necessary (always including the history of the individual and the pattern of the behavior, as well as environmental, health and developmental data.

Before fully engaging in teaching replacement behaviors, some effort should be made to test the analyst’s hypotheses (hypothesis testing).  This describes the process of testing out different ways to elicit the behavior by changing aspects of the environment.  Responses to various forms of intervention can also be tested preliminarily by a similar process.

Once a hypothesis of the ‘function(s)’ of the behavior is done, the analyst looks for “replacement behaviors” for the behaviors the individual is currently using.  So if a child engages in a behavior such as a tantrum, and the hypothesis is that the tantrums are primarily used by the individual as a means to avoid certain demands, then the analyst can propose possible and more satisfactory behaviors to meet that function, or make modifications to the environment that allow the individual to solve the prom or conflict in other ways (e.g. ask for a break; engage in verbal problem-solving/conflict resolution, etc.).  The analyst also has the responsibility of proposing teaching procedures to accomplish the learning of replacement behaviors, as well as ways to ensure the individual can use them consistently when needed.

Equally important is the measurement of behavior change following intervention.  It is well known that an individual can do the same thing for a variety of reasons, depending on the context perhaps (single form: various functions), and conversely, an individual can do a variety of things for the same reason (various forms: single function).  The analysts job is to make sense of this and to develop procedures that work.  If this is done properly, it is often a complicated thing to do – as people and their behaviors can be very complex.

The basic data points of functional analyses are the stimuli that elicit responses (antecedents), the responses themselves (behaviors), and the effects the behaviors produce in the individual or the environment or both (consequences) or (ABC).  Intervention might center on modifying the antecedents or the consequences or both, and the measurement of success or failure is the change in behavior that results from such manipulation of the environment.

This functional unit of analysis: antecedent ® behavior ® consequence is rarely enough, because the results of behavior produce new stimuli that the environment responds to, and the individual responds to the responses of the environment in continuous fashion.  Therefore, behavioral interaction with the environment should be seen as dynamic.  A simple ABC is usually overly static to analyze what is essentially a dynamic process.  Unfortunately, systems theory has only recently even been discussed in FAB, and has not become common in FABs performed by behaviorists.

Consistently in the behavioral literature, the following motivations are identified almost to the exclusion of all others:

• behavior that elicits attention or obtains access to desired events (e.g., access to toys, desired activities);
• behavior that enables the person to avoid or escape demands or other unwanted events/activities, and;
• behavior that occurs because of its sensory consequences (relieves pain, feels good, etc.).

We note here that the primary driving force in the evolutionary expansion of the human brain occurred due to environmental pressure to engage in complex social relationships.  Traditional behaviorists typically place behaviors in one of the three functions above, and many believe that any behavior can be subsumed under one of these functions.  In light of the primary function of social intelligence in human development and the brain, these functions are limited to instrumental interactions among people, not interpersonal or intersubjective motivations.  This has led to interventions devoid of the tools of social intelligence – dynamic appraisal and dynamic responding.  That is why after years of non-developmental intervention, many individuals merely become more knowledgeable individuals with still-disabling autism, as the core [read:] emotional deficits of autism remain unremediated.

Despite my serious criticism of the stagnant state of the field in which I work and the collective hubris of many that call themselves “behaviorists,” a proper Functional Analysis (i.e. informed by developmental data and the sciences related to human neurological, social and emotional development) of developmental interventions can show the actual conscilience of the various behavioral and developmental interventions.

Functional Analysis of Methods Used in Autism Treatment, including “Developmental” Methods

DTT: Discrete Trial Training features the most basic form of functional analysis – the linear relationship between antecedents, behaviors, and consequences.  Using highly controlled presentations, the ABC elements are laid bare and the results are easily measured.  This is the true reason it is the most widely used intervention, not it’s validity as an intervention.  Because of the training method, the stimuli produce responses mainly from long term memory and do not activate the emotional brain in a typical way.  Dynamic social responses rely heavily on limbic influence on feelings, motivations, and behavior, and these are systematically ignored when behaviors are taught in a static (rehearsed and drilled) fashion.  No amount of “generalization training” addresses the fact that dynamic function in the environment is highly predicated on activation of the emotional brain, and the result of this therapy when used alone is typically a smarter autistic who is as unable to function in a truly dynamic social environment as ever.

Floortime: Floortime is the most psychodynamic of the research-based interventions for autism.  By design, the adult follows the child’s lead in the early stages of intervention.  But the point is to engage the child in a co-regulated interaction where each partner’s behavior stimulates congruent responses from the other – in continuous fashion.  Therefore, a 2 minute interaction could involve dozens of continual stimuli, responses, and consequences (called “circles of communication”).

The interventionist sees the child’s behavior as the antecedent, because the focus of intervention is to create a connection between affect (feelings, intent; motivation, and the outward expression of these as observed in emotional and symbolic communications emanating from the partners) and motor planning (formulating responses related to intent).  The adult responds by facilitating the child’s behaviors related to the [hypothesized] intent of the child, and/or providing challenges (stimuli in which the child is to formulate a response) that result in developmental growth.  The Therapist looks for opportunities (again the child’s behavior) to create extended, intersubjective responding.

It is this intersubjective component that annoys behaviorists the most, because it makes assumptions about the inner workings of another person’s mind.  But this is what we do constantly in human interaction – we are always sussing out the motivations and intentions of our social partners.  People who cannot do it are well – autistic, so Floortime addresses the core deficits of autism.

And what is a functional hypothesis of behavior anyway?  It seems that here, the only difference between the way a Floortimer and a Behaviorist analyzes behaviors is that the Floortimer will acknowledge the intersubjective nature of human interaction and be unafraid of analyzing it.  He or she sees emotion signaling as a valid domain of expressive behavior, and the ability to read emotion signaling in a normal way as a valid domain of receptive knowledge – as demonstrated by the congruence (or lack of it) in the child’s response.

In Floortime, the interventionist has to formulate hypotheses on the fly, because a major emphasis is on fluid and spontaneous responding.  The hypotheses are continually evaluated in terms of the child’s responses.  Because the interventionist must respond fluidly to the child’s behaviors – there is no time to stop the interaction to take data.  This really sets it apart from PRT, a behavioral form of child-led intervention, and unfortunately has become a source of criticism from behaviorists.  This is totally unfair because developmentalists have used video/film for this purpose for more than 40 years.  This allows functional analysis at the micro and macro levels.

One difference in the method is that the interventionist is looking for a congruent response, one that facilitates the ongoing interaction.  The interventionist is less concerned about eliciting any specific or delimited form of behavior than a behaviorist might be.  If a child produces a response that at the moment is not consistent or fully intentional on the part of the child, the interventionist responds in ways that “shape” more efficient responses – which is exactly the same thing as the behaviorist principle of behavioral shaping.   The Floortimer always has the response (skill) they would like to elicit in mind – the “behavior” or the ‘B’ in FAB, and develops a working knowledge of how to consequate (respond to the behavior of) the child.  This consequation (a behavioral term), when it is sensitive to the child’s emotion signals is referred to as attunement.  The more attuned the interventionist, the more the child responds and the more “material” is presented by the child to the interventionist (opportunities) for behavioral shaping (consequation with the intent of forming specific forms of behavior).

Real Floortimers must be well versed in emotional development and be able to recognize emotion signals emanating from the child.  They must know the order of development of these signals, which provides the bulk of behavioral goals for the child.  If these behaviors are taught out of order, the brain recruits cognitive systems designed for stepwise thinking, not intersubjective responding.  Emotional or limbic parts of the brain are designed for this and respond most efficiently to emotional input (stimuli).

Without being able to recognize emotion signals, we could not engage in warm, dynamic, intersubjective and spontaneous social interaction – so it is reasonable to be able to teach children to respond to such signals by systematically exposing the children to and helping them respond to them.  Most emotion signals are nonverbal, so there is a great deal of emphasis on providing emotion signals (stimuli) for the child to respond to.

A criticism I have along with many others of Floortime in its purist forms is that in a given period of time, you may not have as many opportunities to work on the skills you want.  Oh, there are always opportunities for teaching, but you may or may not get the opportunity to work on the skill you intended.  In theory, Floortimers will tell you that they will respond and shape any behavior that is developmentally appropriate for the stage of development in which the child functions, and Greenspan and Wieder have done a thorough job of delineating these behaviors by stage – as observed from extensive research into neurotypical infant and child development.

But we often prefer a little more structure than simply following a child’s lead anywhere.  When we do it, we will set up the environment to promote opportunities – which often involves not using toys or objects to support interaction.

Pivotal Response Training: This is another form of child-led method, developed by disciples of Lovaas that found that DTT relied too heavily on manipulative, unnatural forms of motivating the child.  “Motivation” is considered a foundational, pivotal response underlying all others.  Therefore, they look for ways to produce natural motivation from the child.  Too bad that emotion signals and emotion-sharing are not identified as stimuli for the child to respond (although so-called “social reinforcement” such as praise can, but doesn’t necessarily or always result in emotion-sharing).  Access to essentially non-social stimuli constitutes the motivating consequence for social behaviors, which can reinforce the autistic child’s natural bias towards instrumental (and not intersubjective) forms of motivation.  There is only the hope that learning to interact in such a way will lead to the child developing a taste for emotion sharing, but there is no systematic way identified in the method to elicit the child to reference other people’s affective signals or to be able to read the non-verbal ones.

In the emotion development-informed methods such as Floortime or RDI, emotion-sharing is used as the main “reinforcer” – not mere access to a toy or activity the child likes.  Granting access to toys or activities the child already likes as a “reinforcer” can exacerbate the self-referenced nature of the individual with ASD, and turn the relationship into a series of instrumental contracts with the child.  We do not want children to evaluate their own behavior in terms of obtaining access to things; we want them to evaluate their behavior in terms of the emotional and social responses of others – so we would never develop such contractual relationships with the child.  True, the social/emotional forms of feedback are contingent upon responses from the child, which conforms to traditional notions of contingency in functional analysis, but they are not related at all to the child’s access to things (non-social objects).  Should your motivation come from wanting to be with me – or to get to your video game?  If it’s the former, you’re normal.  If the latter – you remain socially and emotionally impaired.

We use PRT sometimes to enhance how children play with toys – but not people.  If we want to teach social/emotion interaction skills (in other words – remediate the core deficit underlying all the other core deficits of autism), we modify PRT to provide emotion signals as “reinforcers” for the child.  This will not work without first facilitating emotion-sharing without physical objects involved.

Guided Participation Teaching (GPT): An oversimplified analogy for GPT might be: “behavioral methods: emotional goals.” Techniques such as Stop the Action are really forms of differential reinforcement and behavioral shaping.

Note: Guided Participation Teaching is a concept identified by Russian Psychologist Lev Vygotsky and further elaborated on by Anthropologist Barbara Rogoff.  Psychologists, Steven Gutstein and Rachelle Sheely adapted many of the principles of GPT for autism in their method known as Relationship Development Intervention or RDI.™  I was certified in the RDI method from 2004 to 2012, choosing to give up the certification voluntarily and in good standing, in order to pursue Floortime Advanced Certification.

Based on work on systems and human behavior by Alan Fogel, a change in the ongoing regulatory pattern of an interaction is considered the antecedent in which a child is to respond.  In this respect, it is the same as Floortime, except that the adult structures and teaches with specificity the initial regulatory pattern.  The Guided Participation teacher is looking for specific and delimited skills one at a time as the behaviorist does, but the difference again is the focus on emotion reading and signaling skills and the emphasis on the proper neurologically based emotional developmental sequence of skills instruction.

We’ve done DTT by using emotion signals exclusively for feedback to the child.  We’ve done GPT in situations where what we want to teach is how to use an object or perform an instrumental skill such as getting dressed.  We’ve used Floortime to make anything we do fun, so we can get kids to want to wash their hands and brush their teach from the foundations built from intersubjective connecting with the child.  And we the Stop the Action technique to deal with inappropriate behavior.

This is what is possible when you can truly find the conscilience among the methods.  So if a professional tells you their method is incompatible with the any of the others you might want for your child, you now know better.  Maybe they should read this.  And you should look for professionals who are in a position to evaluate therapies objectively – not out of bias or ignorance.

• Our Philosophy and Guiding Principles Regarding ABA and Functional Analysis
• How We Develop Programs at SCS
• Criticism of Functional Analysis of Behavior
• ABA Concepts
• Early Intensive Behavioral Intervention (EIBI)
• Is ABA the ‘Only’ Way?
• ABA Jobs at SCS

Basic Tenets of the SCS Philosophy on the Functional Analysis of Behavior

The field of ABA demands a scientific approach, but we never forget that we’re there for a person and a family – not just to change behaviors and teach skills.  We are proud of the fact that we can use the scientific standards of ABA to offer developmentally appropriate, relationship-oriented services that focus on Quality of Life…    Read More…

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People with autism make an extremely diverse a group.  The saying goes, if you’ve met one person with autism, you’ve met one person with autism.  Which type of therapy is right for your family?  The answers parents get from the professional community is usually more bias than fact.  This article will help you filter through what you are likely to or already have been told…  Read More…

How We Develop Programs at SCS

Assessment

While we ultimately want to know why behavior occurs, we understand that people respond to their perception of reality rather than reality itself.  We have a very unique way of assessing behavior that meets the standards of reliability and verification that ABA demands, but is also powerful enough to consider a person’s behavior relates to their unique experience of the world…   Read More…

Early Intervention

There is wide range of choices available for deciding how to apply ABA in early intervention.  There is also a wide range of choices for combining developmental and ABA techniques.  Any methodology or individual technique, whether it claims to be “ABA” or not, can be evaluated using ABA standards of validity (“Applied”), reliability (“Behavioral”) and verification (“Analytical”).

How We Develop Programs for Accelerating Development

It’s way more than ABA…  Read More…

How We Develop Programs: Program “Prescription“

You probably found out that for many professionals, “ABA” really means “one way of doing things.”  That is not ABA.  Here, we describe how we use other, very important scientific disciplines along with ABA to develop a unique program “prescription” for your child.   Read More…

How We Develop Goals for Programming: Goals v. Objectives

This article is a bit technical, meant for students of ABA and Functional Analysis, Therapists, Consultants, Teachers and other professionals in the field.  It is about how to properly develop, measure and evaluate progress on goals for developmental/behavioral change. 

Parents may want to know whether the goals and objectives in their child’s IEP or program plan are properly written…   Read More…

ABA Concepts

Behavioral science and behavioral psychology began in laboratories, always using tightly controlled research experiments and animals as research subjects.  Much was learned about how behavior works in all species from these experiments.  However, what was possible in terms of control and freedom to use experimental techniques in the laboratory was not possible or desirable with people or in social settings.

Applied Behavior Analysis (ABA) refers to the use of principles derived from laboratories of TEAB to the real world of homes, schools, classrooms and other areas of real life.  Since it’s advent in the 1950’s and 60’s (and a seminal paper that officially started the field [and Journal -] of ABA in 1968), new methods and adaptations had to be developed from the original material discovered in laboratories.  A whole different set of realities, ethics, emphases and procedures had to evolve that were not only “socially important” (an essential tenet of ABA, but not TEAB), but viable and practical in public settings.

In the laboratory, control over the elements was paramount, so a primary emphasis was on the isolation of the specific elements involved in change and the relationships between the changes made and the results obtained.  Such precision may not be possible or even desirable in the real world.  There is often a recognized trade-off between what is the most socially important and useful, and what is the most precise.

Because laboratory conditions may not available, or they may even be objectionable if used on people in a social setting, the ABA professional looks for [or invents] other ways of analyzing the variables to maximize certainty and predictability of outcomes.  For instance, in the real world, one may not want to make changes to the environment just to make things easier to measure.  Instead, the ABA professional would look at ways of making the measurement procedure more practical.  In the laboratory, a researcher may rearrange variables thought to be responsible for improvement – just to show which variable was responsible for the change.  In the real world, one may not want to reverse improvement just to make a point about a theory or procedure, whereas in the laboratory this may be necessary to fully validate a principle.

Still, the vast majority of techniques used in current practice are identical to or they are derived from techniques developed in laboratories.  There are too many to list here and if you are interested in ABA, it is best to consult sites dedicated to information on ABA.

The following articles look at common  practices used in ABA from a technical, practical and most of all, objective point of view… 

What “Positive Reinforcement” and “Positive Reinforcers” Really Mean: A Brief Working Definition

Learn the pros and cons of artificial reinforcement and the differences and between “positive reinforcement” and positive behavioral support…”   Read More…

Mastery is the “Reinforcer“

Learn how acquiring traits or persistence, resilience and a desire for mastery can easily replace the need for bribes, threats and punishment…  Read More…

Baseline Logic

No matter how far we’ve come or how good we think we are, no one can ever know why anyone really does anything.  We can only have a “hypothesis” as to why a person behaves in one way or another…  Read More…

Prompting – Pros, Cons, and Otherwise

Studying ABA, as well as Relationship/Based, Neurodevelopmental methods, teaches us there can be beneficial and harmful forms of prompting.  Beneficial forms lead to new ways of thinking, whereas harmful forms can lead to dependence, power struggles, or further inflexibility…   Read More…

Glossary of Terms Used in Applied Behavior Analysis

Right now – we’re borrowing one. This glossary is entirely of terms used in ABA.  Read More…

In the future, we hope to include definitions for terms we use elsewhere on this site from Neurodevelopment and Child Development, Autism and Developmental Psychopathology, Systems Theory, DIR/Floortime and Guided Participation among others.

Early Intensive Behavioral Intervention (EIBI)

Intensive Programming – What does that mean?

What do they mean by “intensive” in Early Intensive Behavior Intervention?  Read More…

An Applied Behavioral Analysis of some Developmental Techniques

ABA’s real strength is its guidelines fo evaluating the Validity, Accuracy, and Reliability of Teaching.  In this article, Applied Behavioral Analysis guidelines are used to evaluate some developmental methods

Criticism of Functional Analysis of Behavior

We look at all methodologies for what they are.  “Methods, not Religions” is a fair assessment of our attitude.

• No method is ideal for every situation
• No method is ideal for every person or family or context
• Parents and Families are entitled to a choice and to the full range of information

Because we do not have an ideological commitment to any single theory of behavior or unimodal intervention, we can afford to look not only at the advantages of a technique, but its shortcomings as well.  This provides opportunity to make it better.

Our own use of ABA is consistent with the rest of our philosophy.  It is informed by what we know from other scientific disciplines and adapted according to cardinal rules of scientific accuracy And inquiry established by TEAB and ABA.

Functional Behavioral Assessment: Deeper Understanding of Behavioral Handicaps or Trojan Horse?

This article was written by John Stewart, Ph.D., author of “Beyond Time Out”  It points out some important shortcomings of the current practice of Functional Assessment of Behavior.  Read More…

Is ABA the Only Way?

This seminal essay, written by Dr. Barry Prizant, one of the most established authorities of Autism and Communication, reminds us that a thorough knowledge of child development is not only required for quality intervention for Autism, but much of the techniques currently in use come from the research and practice of child development.  It’s not either/or, it’s both…  Read More…

ABA Jobs at SCS

Behavior Intervention (“BI”) Consultant/Analyst

The BI Consultant helps Parents, Teachers and other significant others understand the behavior and collaborates with them to develop means of improving behavior and teaching improved skills.

Applicants must have experience and have completed training in Psychology; ABA; Family Therapy, or in one of the Early Intervention Methods (below)… Read More…

Early Intervention Therapist

This person works directly with children and parents, providing Early Intervention for Development and Behavior.

At the supervisory level, we require certification in at least one of the evidence-based approaches to Early Intervention (ABA; DIR; RDI).

At the Therapist/Direct Treatment level, applicants must possess prior training and experience in at least one of the above techniques.  Applicants must be able to demonstrate proficiency and to explain the principles of the approach(es) in their areas of expertise…

Map of a Consultation Model: View from a Parent and a Professional

In case you’re planning to apply at SCS, you might want to read this before you interview…  Read More…

Related Links and Reading

Menu Page: SCS Philosophy, Methodology, and Policy  Read More…

Menu Page: Autism Spectrum and related Disorders of Relating and Communicating.  Read More…

Menu Page: Parent Education and Parenting Techniques  Read More…

 

©David Sponder, L.E.P., BCBA; RDI-CC; DIR C2
Executive Director, Sponderworks Children’s Services

Instructional Activity or “Frame”

The Frame is simply a teachable moment.  You either set it up purposefully and/or plan it carefully, or you respond to natural teaching opportunities that arise spontaneously or unexpectedly in the course of the day.  In the ‘Frame’ you will give the Student a chance to exercise a skill or to think and meet a challenge that you give to him or her.  It is called a “Frame” because the elements described below all go inside this “frame” as the elements of a picture go inside a picture frame.

Many feel that it is easier simply to think of authentic activities first, and then think about the skills that can or will be taught within the activity.  But an activity is not the same as a lesson.  An activity can contain many planned and unplanned lessons.  A frame is more like a moment where there is a chance to work on a specific skill that you’ve been working on in several frames or at any available opportunity.  A frame can pop up at any time where you notice an opportunity to put a spotlight on a skill.

A frame is something that you can throw around practically any type of lesson, whether it be an activity-based and “authentic” activity (the activity has an end product that is meaningful and apparent to the Student), a traditional academic lesson (where the Student engages in only a part of a greater sequence of skills), a social interaction, sports activity or play, or a moment where an opportunity to work on a spotlighted skill comes up spontaneously.  What I mean by “throwing a frame” around something means that whether you’ve planned it in advance or not, you can turn “frame the activity” by including the following elements:

• A spotlight on a skill targeted for development

• The skill in the spotlight (e.g., responding to nonverbal cues to slow down or speed up actions; finding reference points that let one know if or how long to wait)
  • Whatever constitutes observable and/or measurable criteria for demonstration or mastery of the skill
• Role actions for each Role
• Moves or actions you will take or arrange to take place the provide opportunities for the Student to develop the skill.  THE GUIDE or Teacher, always has the responsibility for setting up or taking advantage of a teaching moment.
• Patterns or Systems of Interaction: All interdependent activities require the partners to work hand in hand, providing reference points for each other (e.g., topic changes; changes of speed or intensity or tone; presentation or removal of objects; changes in the task actions required as the task develops, etc.)
• Noticeable changes in the activity pattern that provide opportunities to think, search for points of reference to figure out what to do, and opportunities for the Student to discover or invent new ways to respond
• A moment where you slow down, stop or do something otherwise unexpected, that cues the Student to think or try a new way of responding.  This is very different from telling a Student what to do or giving directions and direct prompts.
• Using Mastery as a Reinforcer: success in meeting the challenge should be reinforcing and noticeable enough to the Student.  You shouldn’t have to say “Good job!” or offer any other incentives.
• Explicit/Announced v. Nonverbal/Unannounced References: To introduce a new skill, you might want to start with very big and noticeable cues.  You may also want to preview with the Student what he or she should be looking for (after that – the Student should rely on discovery rather than prompts or directions).  Think of spectra of overt to covert cues, loud to soft ones, big to small ones.“Ready/Set/Go” is an example of an explicit or announced cue.  At first, this can be done loud, regular and slow to ensure maximal coordination.  It can then be faded to softly announcing; “Ready/Set [head nod]” or just nods of the head or lifting the eyebrows.
• Eliminating Competition for the Student’s attention:  At every moment, be observant of what typically interferes with the Student’s ability to pay full and mindful attention to the reference points that lead to skill development and problem solving.Do what you can to eliminate the competition.  At first, you may want to work in relatively quiet, clean environments where there is little else to attend to other than relevant reference points for action, thinking, problem-solving, etc…Later on, you’ll want to introduce messier environments with normal levels of distraction and irrelevant cues.
• Zone of Effectiveness: Since you use proximity to increase your noticeability and power when you need to (as opposed to getting louder, repeating yourself, or signs of desperation and ineffective teaching, etc.), you will “just know” when you are in and out of a zone in which you remain effectively engaged with the Student.  In the zone, the Student responds to your actions in as mindful of a manner possible for the Student.  Outside the zone, the Student attends to cues that are irrelevant to spotlighted skill or challenge.
• Variations of the Challenge: This is similar to “generalization” procedures used in ABA or Special Education.  Once the Student’s success is regularly observed, it is time to vary the types of reference points he or she must respond to or the ways in which he or she can respond to the same cues, or to increase the complexities involved in the activity (the reference points aren’t so obvious).

• Roles for you (as the Guide or Social Co-regulation partner) and the Student.

• Challenges

• Frame Scaffolding: These are other aspects of any lesson of frame that you’ll need to think of:

Teaching Frames vary by formality and the amount of prior planning that go into them.

I call Formal Frames those in which the activity is really designed around the skill.

For instance, the Student may be learning to recognize nonverbal cues for starting and stopping actions.  The Teacher/Guide might organize the following frames:

• Playing a Game of Red Light/Green Light
• Walking together, where the Student has to use the Guide’s starting and stopping as a reference point
• Playing a game of “Freeze”
• Musical Chairs – but the Guide blinks or does some other nonverbal behavior as the sign for starting and stopping instead of music

I call Embedded Frames those that you can find within other activities.  The Guide starts with any naturally occurring activity (e.g., eating dinner together; cleaning up; taking a walk; going to the mall, etc.) and then looks for opportunities within them that yield opportunities to work on the skill.  Using the same example of recognizing nonverbal cues for starting and stopping actions…

• The Student fills a container while watching the Guide for a type of nonverbal cue to start, continue or stop filling the container
• When playing catch, the Student learns to throw the ball only when someone is looking or not (‘looking/not looking’ being the nonverbal reference point for throwing)
• The Student stops talking when the Guide shows obvious signs of not paying attention (e.g. covering ears; looking away; walking away; turning her back)
• When crossing a parking lot, the Student starts and stops walking by using the Guides starting and stopping as a reference point

Spontaneous Frames are those that come up unexpectedly but that provide clear opportunities to exercise a skill.  In spontaneous frames, especially if there has been enough work and preparation with the skill in previous frames, there is the advantage of the Guide being able to recognize opportunities when they occur, and to have some idea of the scaffolding required beforehand.

Again, using the same example of recognizing nonverbal cues for starting and stopping actions…

• You can always use established or noticeable reference points when the Student’s behavior is inappropriate.  For instance, Guides may use established facial gestures as cues to start or stop the behavior
• If any activity requires interdependent roles, the Student can learn the specific environmental reference points that function naturally as cues for starting and stopping (e.g., seeing the other children stop and start functions as a cue for the Student’s starting and stopping; partners carry a bag or chest that has two handles – requiring the coordinated starting and stopping of action in order to hold on).

The effectiveness of the Guide depends on providing as many opportunities as possible to work on the skill.  Being able to recognize natural and spontaneous frames for the skill allows Guides to be more effective.

Guided Participation Menu Card: Articles on Guided Participation teaching and framing techniques

Framing Sheets: These are blank templates that help you organize and plan opportunities that develop a skill.

Examples of Teaching/Skill Frames and the use of Framing Sheets

Framing Sheet Example 1: Spotlight on “Personal Space”

Framing Sheet Example 2: Spotlight on “Prosody”

Framing Sheet Example 3: Spotlight on Topic Changes

Blank Framing Template

 

Framing Sheet

Spotlight:

Frame(s):

Formal:

Embedded:

Spontaneous:

Roles:

Guide:

Student:

Pattern or System of Interaction

Challenges:

Mastery as a Reinforcer:

Scaffolding:

Zone of Effective Coordination:

Variations of the Challenge:

Informal Frames:

Spontaneous Frames:

 

Notes:

Spotlight:  Student recognizes when topics change in conversation and makes relevant utterances

Frame(s):

Formal:

• Guide and another model hold a conversation.  Student raises hand when she notices a change in topic.  At that point, the Guides stop and ask,

“What are we talking about now?”
“What were we talking about?”
“How did you know the topic changed.”
“What might you say next?”  “What else?”

• Tape record conversations and do the same thing – stopping the audio when the Student recognizes the topic change.  Stop the audio and replay it if the Student fails to notice and give her another chance.  Once the audio is stopped, ask the above questions.
• Look at written passages.  New paragraphs usually indicate topic changes for you – so look for fiction or novels where this isn’t always so obvious.  When you stop reading, ask the above questions.

Embedded:

• Student is prepared to listen for topic changes during social coordinated activities, but may be asked not to participate for a while – just listen.   Privately, ask the Student the above questions.
• Encourage the Student to join easier, slower conversations, perhaps with younger individuals.  Do not allow the Student to dominate or control the conversation by bringing the subject back to favored topics or staying on the topic after others have switched.

Spontaneous:

• Encourage the Student to join easier, slower conversations, as above
• Develop covert signals that the Guide can give when the Student is in the midst of error (dominating or controlling the conversation;  returning, apropos of nothing to favored topics or staying on a topic after others have switched) and that cue the Student to listen for a moment for the topic and then rejoin

Roles:

Guide: Sets up and looks for opportunities to spotlight the skill (always: this does not have to be included in the Framing Sheets for typical activities as it is implied in Guided Participation Teaching [GPT])

• See the formal, embedded and spontaneous frames above

Student:

• Pays attention to changes in topics and makes comments or utterances that allow the interaction to flow; rather than trying to control the topics or ignore topic changes

Pattern or System of Interaction

• Mainly conversational, but also in written compositions

Challenges: Student has difficulty getting her ideas out and tends to stop tracking the verbal and nonverbal events going on around her.  Student does not like to be interrupted or taken off of her topic for fear of losing her place or her control of the conversation.  Student also tends to engage enthusiastically in only a few favorite topic areas.  She tends to talk about these regardless of signs of disinterest or boredom from others.

Mastery as a Reinforcer:  Involving the Student in a wide variety of authentic activities – despite protests, should broaden her horizons.  This process should lead to conversations on more topics becoming more rewarding.

Scaffolding:

• Formal activities have the effect of slowing things down and frequent stopping to allow the Student to switch from output (talking) to input (tracking and monitoring cues of topic changes and changing feelings on the subject matter that others emit)
• Will preview with the Student the spotlight (proximity) before the activity, and then rely on short pauses to make the opportunities and challenges more noticeable and as cues to listen again and reformulate responses
• Student will learn gestural cues that Guides can use to cue the Student covertly during spontaneous frames

Zone of Effective Coordination:

• Guide increases proximity when the Student is no longer tracking and monitoring the conversation
• Guide emphasizes or adds a little more force to comments on the new topic; ignores comments that are      no longer relevant

Variations of the Challenge:  Speed up conversation and increase the number of topic changes to natural levels

Informal Frames that spotlight the same types of reference points and skill could be embedded in any other activity:

• Shopping together: Shop by topic (e.g., items needed for a recipe; fruits on the list; what will be needed for a party).  Shift topics on purpose; ignore any irrelevant conversation and provide new and different leads for the Student to catch on.
• Sports: Change directions in which the ball is to be thrown
• Activity pairs: Student first listens and then joins; Student is encouraged to take regular breaks just to listen.  Guide uses covert – pre-arranged signals that cue the Student to stop talking (outputting) and listen (input: track and monitor).

Spontaneous Frames: The Guide will change topics and use short pauses or exaggerated signals to indicate the Student is going on and on.  Guide helps with “leads” the Student can follow in order to rejoin the conversation

Spotlight:  Prosody: Student attends to how elements of prosody change the meaning of the words and phrases others use; Student learns to use prosody more effectively

Frame(s):

Formal:

• Guide says utterances in exaggerated tones, and the Student either names or selects from a list of possible emotional meanings, the intention or emotional tone of the speaker; Guide gives feedback with nonverbal smiles or nods or shaking head “No” or a facial gesture that indicates “Close, but not quite right…”
• Start with the Student’s name and say it in various ways implying various meanings or intentions… (example “Joe”)“Joe” (warm welcoming; happy; with a smile)

“Joe!” (sharp; angry; as if demanding to stop doing something he’s doing)
“Joe?!” (surprised)
“Joe” (sneering/disgusted)
“Joe?” (Really?)

• Read short passages or phrases (as above and below)…
• Read like a robot/monotone
  • Read in monotones more like the ones used by the Student, but not in a mocking way
  • Read in an exaggerated, ham acting style (a la Pee Wee Herman; Stentorian; Shakespearean, etc.).  Exaggerate and have fun with it
  • Read like a girl; boy
  • Read with various emotions (e.g., angrily; embarrassed; surprised; disgusted…)
  • Student and Guide pick cards that have emotion labels (e.g., angry; embarrassed; surprised; disgusted…).  Cards are placed face-down.  Read passages in that tone.
• Have wordless conversations, where only sounds can provide feedback or direction.  Sound like you are actually talking, but with no words.
• Make tapes of the Guide or peers saying various things in clear, if not exaggerated prosodic tones.  Ask the Student to tell you what the speaker really means.

Embedded:

• Student is prepared beforehand to listen for certain prosodic signals during social coordinated activities. The frame includes some private verbal reminding by the Guide before starting the activity (“List to the way I say it.  I may be sarcastic – where I mean the opposite of what I say).
• Frame the activity so that prosodic tone is the signal (reference point) the Student uses to figure out what he or she is really supposed to do or how to react

Spontaneous:

• Students make utterances that are sarcastic or that infer other meanings than the [concrete] dictionary definition of the word
• TV shows and other media

Roles:

Guide: Sets up and looks for opportunities to spotlight the skill (always: this does not have to be included in the Framing Sheets for typical activities as it is implied in Guided Participation Teaching [GPT])

• Provides dynamic reference points that help the Student understand what others truly mean by way of their prosodic additions to their words.  Does this by exaggerating and amplifying when necessary or stopping for a moment as a cue to think

Student:

• Reads intentions from prosody and continues the activity or interaction by responding to both the words and gestures

Pattern or System of Interaction

• All (Sequential, Complementary, Parallel, Role-Reversed, Giver – Doer, etc.); patterns must require some vocal element in the coordination

Challenges: Student tends to lose track of prosodic elements when language is complex or interactions go on too long; slow down and shorten interactions, or stop the action for a moment to give the Student time to think and discover and adjust

Noticeable changes: Exaggerating emotional inflections to noticeable levels and then making adjustments that show accurate interpretation…

•  “Joe” (warm welcoming; happy; with a smile)
  Joins in; continues speaking or doing because of approval in the sound of the other’s voice
•  “Joe!” (sharp; angry)
  Stops abruptly; looks for reference points or cues as to what corrections or adjustments should be made or what to do instead/next
• “Joe?!” (surprised)
  Makes confirmatory gestures or statements; clarifies or restates
• “Joe” (sneering/disgusted)
  Checks self for disgusting or off-putting behaviors; looks around for any kind of feedback or reference point that will help him or her know how to adjust (Guide can help out with more explicit cues or ways of guiding the Student to relevant reference points)
•  “Joe?” (Really?)
  Makes confirmatory gestures or statements; clarifies or restates

Mastery as a Reinforcer:  Student will feel more confident that he is reading others intentions correctly, lowering anxiety and increasing the harmony and synchrony of social interaction; Student may make gains in listening and reading comprehension.

Scaffolding:

• In preliminary (formal) activities, Student will learn prosodic elements others add to utterances, as well as vocalizations (wordless sounds uttered) that discriminate one meaning of the utterance from other possible meanings as in the examples above

• Student will learn first from exaggerated/amplified cues done in formal activities.  Once the Student’s “antennae” are sensitized, we will “dial down the volume” of these cues to levels more expected in typical environments

• Will preview with the Student the spotlight (proximity) before the activity, and then rely on exaggeration/amplification to make the opportunities and challenges more noticeable
• In preliminary (formal)  activities,  Student will learn prosodic cues that Guides can use to cue the Student covertly during spontaneous frames  (exaggeration/amplification and/or combining prosodic reference points with nonverbal facial gestures or body language

Zone of Effective Coordination:

• Guide increases proximity when the Student is no longer paying mindful attention to spotlights and reference points
• Guides can actually raise the decibel level of their voices if necessary (which is generally not a good idea for other spotlights or skills)

Variations of the Challenge:  Continue to add to the list of frames where the skill is worked on.

Informal Frames that spotlight the same types of reference points and skill could be embedded in any other activity:

• Shopping together:

Warm welcoming; happy tones in the words
Continues doing what he is doing because of approval in the sound of the other’s voice

“Sharp; angry
Stops abruptly; looks for reference points or cues as to what corrections or adjustments should be made or what to do instead/next

Surprised
Makes confirmatory gestures or statements; clarifies or restates

Sneering/disgusted
Checks self for disgusting or off-putting behaviors; looks around for any kind of feedback or reference point that will help him or her know how to adjust (Guide can help out with more explicit cues or ways of guiding the Student to relevant reference points)

Really?
Makes confirmatory gestures or statements; clarifies or restates

• Sports: The Student responds to prosodic meanings in the play rather than just the words; insert vocal sounds as cues to how you feel about an event or the Student’s actions; make a rule that no one can use words – only sounds and gestures while playing
• Activity pairs: Student performs activities with a peer using only sounds and gestures

Spontaneous Frames: The Guide will vary activities in ways that require interpreting sarcasm or emphatic tones

 

Spotlight:  Personal Space: Student recognizes nonverbal, natural reference points that indicate whether he is appropriately close, too close or not close enough

Frame(s):

Formal:

1. Student and Guide walk towards or away from each other and the Student learns to move in or out based on various nonverbal cues given by the Guide;
2. Student and Guide throw the ball back and forth, throwing the ball pretty hard; the Student either backs up or throws the ball softer when close and does the opposite when further away

Embedded:

1. Student is prepared to look for certain “back off” signals during conversations. The frame includes some private verbal reminding by the Guide before entering into the room.
2. Student learns to observe the spacing used by other peers when they set up their chairs to watch a movie, or as they take seats in the lunchroom.  Student also makes adjustments as needed when nonverbal signals of discomfort with closeness become evident, or the Student is so far away that coordinated social interaction is no longer possible.

Spontaneous:

1. Students gather around as a peer shows a new game on his cell phone
2. A Student pulls out a deck of cards and other players join

Roles:

Guide: Sets up and looks for opportunities to spotlight the skill (always: this does not have to be included in the Framing Sheets for typical activities as it is implied in Guided Participation Teaching [GPT])

• Provides dynamic reference points for how close the person should be (e.g., leans backwards when too close; cups ear or leans forward to indicate the Student is too far.  The Guide exaggerates the cues/references or even stops the action and then “dials them down” as the Student becomes sensitized to the nonverbal signals (reference points).

Student:

• Moves back when he sees the characteristic nonverbal behaviors of others when they feel crowded; moves in when the person stops paying attention to them or shows signs that they cannot hear or see what the Student needs them to

Pattern or System of Interaction

• All (Sequential, Complementary, Parallel, Role-Reversed, Giver – Doer, etc.)

Challenges: Student tends to forget when excited or highly aroused in a positive or negative way.  Will start with low key and explicit cues in low- to medium-key activities

Noticeable changes: Exaggerating closeness/farness to noticeable and unworkable extremes and then making adjustments to get the closeness about right

• too close for comfort; too far to remain coordinated in the back-and-forth
• too close or too far to throw a ball;
• too loud talking when close, not loud enough when far;
• exaggeration of nonverbal signals other people typically send when uncomfortable and farness

Mastery as a Reinforcer: Student will enjoy the formal exercises as they are game-oriented; Student will experience more success and less rejection from others; negative prompts will no longer be required (e.g., “Don’t…” “You can’t…” “Move away…” “Stop,” etc.).

Scaffolding:

• In preliminary (formal) activities, Student will learn facial gestures and body language others      give to signal too close or too far

• Student will learn first from exaggerated/amplified cues done in formal activities.  Once the Student’s “antennae” are sensitized, we will “dial down the volume” of these cues to levels more expected in typical environments

• Will preview with the Student the spotlight (proximity) before the activity, and then rely on exaggeration/amplification to make the opportunities and challenges more      noticeable
• In preliminary (formal) activities, Student will learn facial gestures that Guides can use to cue the Student covertly during spontaneous frames

Zone of Effective Coordination: This lesson is all about the Zone of Effective coordination.  We will try to both set up activities where errors of proximity are noticeable to the Student but not embarrassing or overwhelming

Variations of the Challenge:  Continue to add to the list of frames where the skill is worked on.

Informal Frames that spotlight the same types of reference points and skill could be embedded in any other activity:

• Shopping together: The Student starts and stops pushing the cart when the Guide stops walking.  The Student stops filling the bag when the Guide’s face indicates that they have enough.
• Sports: The Student responds to stops in the play; hand signals for “Time Out”
• Activity pairs: Student performs activities with a peer or the Guide that require a certain proximity

Spontaneous Frames: The Guide will vary activities in ways that require adjustments in closeness/farness (e.g., by lowering, raising voice; passing materials back and forth; etc.)

What is a “Teaching Frame”

© David Sponder, L.E.P.; BCBA; Floortime C3c
Exectutive Director, Sponderworks Children’s Services

Instructional Activity or “Frame”

The Frame is simply a teachable moment.  You either set it up purposefully and/or plan it carefully, or you respond to natural teaching opportunities that arise spontaneously or unexpectedly in the course of the day.  In the ‘Frame’ you will give the Student a chance to exercise a skill or to think and meet a challenge that you give to him or her.  It is called a “Frame” because the elements described below all go inside this “frame” as the elements of a picture go inside a picture frame.

Many feel that it is easier simply to think of authentic activities first, and then think about the skills that can or will be taught within the activity.  But an activity is not the same as a lesson.  An activity can contain many planned and unplanned lessons.  A frame is more like a moment where there is a chance to work on a specific skill that you’ve been working on in several frames or at any available opportunity.  A frame can pop up at any time where you notice an opportunity to put a spotlight on a skill.

A frame is something that you can throw around practically any type of lesson, whether it be an activity-based and “authentic” activity (the activity has an end product that is meaningful and apparent to the Student), a traditional academic lesson (where the Student engages in only a part of a greater sequence of skills), a social interaction, sports activity or play, or a moment where an opportunity to work on a spotlighted skill comes up spontaneously.  What I mean by “throwing a frame” around something means that whether you’ve planned it in advance or not, you can turn “frame the activity” by including the following elements:

• A spotlight on a skill targeted for development
• The skill in the spotlight (e.g., responding to nonverbal cues to slow down or speed up actions; finding reference points that let one know if or how long to wait)
• Whatever constitutes observable and/or measurable criteria for demonstration or mastery of the skill
• Role actions for each Role
• Moves or actions you will take or arrange to take place the provide opportunities for the Student to develop the skill.  THE GUIDE or Teacher, always has the responsibility for setting up or taking advantage of a teaching moment.

Patterns or Systems of Interaction

All interdependent activities require the partners to work hand in hand, providing reference points for each other (e.g., topic changes; changes of speed or intensity or tone; presentation or removal of objects; changes in the task actions required as the task develops, etc.)

• Noticeable changes in the activity pattern that provide opportunities to think, search for points of reference to figure out what to do, and opportunities for the Student to discover or invent new ways to respond
• A moment where you slow down, stop or do something otherwise unexpected, that cues the Student to think or try a new way of responding.  This is very different from telling a Student what to do or giving directions and direct prompts.
• Using Mastery as a Reinforcer: success in meeting the challenge should be reinforcing and noticeable enough to the Student.  You shouldn’t have to say “Good job!” or offer any other incentives.

Explicit/Announced v. Nonverbal/Unannounced References

To introduce a new skill, you might want to start with very big and noticeable cues.  You may also want to preview with the Student what he or she should be looking for (after that – the Student should rely on discovery rather than prompts or directions).  Think of spectra of overt to covert cues, loud to soft ones, big to small ones.

“Ready/Set/Go” is an example of an explicit or announced cue.  At first, this can be done loud, regular and slow to ensure maximal coordination.  It can then be faded to softly announcing; “Ready/Set [head nod]” or just nods of the head or lifting the eyebrows.

Eliminating Competition for the Student’s attention

At every moment, be observant of what typically interferes with the Student’s ability to pay full and mindful attention to the reference points that lead to skill development and problem solving.

Do what you can to eliminate the competition.  At first, you may want to work in relatively quiet, clean environments where there is little else to attend to other than relevant reference points for action, thinking, problem-solving, etc…

Later on, you’ll want to introduce messier environments with normal levels of distraction and irrelevant cues.

Zone of Effectiveness

Since you use proximity to increase your noticeability and power when you need to (as opposed to getting louder, repeating yourself, or signs of desperation and ineffective teaching, etc.), you will “just know” when you are in and out of a zone in which you remain effectively engaged with the Student.  In the zone, the Student responds to your actions in as mindful of a manner possible for the Student.  Outside the zone, the Student attends to cues that are irrelevant to spotlighted skill or challenge.

Variations of the Challenge

This is similar to “generalization” procedures used in ABA or Special Education.  Once the Student’s success is regularly observed, it is time to vary the types of reference points he or she must respond to or the ways in which he or she can respond to the same cues, or to increase the complexities involved in the activity (the reference points aren’t so obvious).

Roles

These include the specific roles and responsibilities for you (as the Guide or Social Co-regulation partner) and the Student.

Challenges

Guides provide regular challenges for the Student to think.  This is the essence of teaching dynamic thinking skills.  It is a way for a Student to learn by discovery and by trying different things.  This is a much more effective way of teaching than by giving instructions and prompts.

Frame Scaffolding

These are other aspects of any lesson of frame that you’ll need to think of.  Teaching Frames vary by formality and the amount of prior planning that go into them.

Types of Frames

Formal Frames

I call Formal Frames those in which the activity is really designed around the skill.

For instance, the Student may be learning to recognize nonverbal cues for starting and stopping actions.  The Teacher/Guide might organize the following frames:

• Playing a Game of Red Light/Green Light
• Walking together, where the Student has to use the Guide’s starting and stopping as a reference point
• Playing a game of “Freeze”
• Musical Chairs – but the Guide blinks or does some other nonverbal behavior as the sign for starting and stopping instead of music

Embedded Frames

I call Embedded Frames those that you can find within other activities.  The Guide starts with any naturally occurring activity (e.g., eating dinner together; cleaning up; taking a walk; going to the mall, etc.) and then looks for opportunities within them that yield opportunities to work on the skill.  Using the same example of recognizing nonverbal cues for starting and stopping actions…

• The Student fills a container while watching the Guide for a type of nonverbal cue to start, continue or stop filling the container
• When playing catch, the Student learns to throw the ball only when someone is looking or not (‘looking/not looking’ being the nonverbal reference point for throwing)
• The Student stops talking when the Guide shows obvious signs of not paying attention (e.g. covering ears; looking away; walking away; turning her back)
• When crossing a parking lot, the Student starts and stops walking by using the Guides starting and stopping as a reference point

Spontaneous Frames

Spontaneous Frames are those that come up unexpectedly but that provide clear opportunities to exercise a skill.  In spontaneous frames, especially if there has been enough work and preparation with the skill in previous frames, there is the advantage of the Guide being able to recognize opportunities when they occur, and to have some idea of the scaffolding required beforehand.

Again, using the same example of recognizing nonverbal cues for starting and stopping actions…

• You can always use established or noticeable reference points when the Student’s behavior is inappropriate.  For instance, Guides may use established facial gestures as cues to start or stop the behavior
• If any activity requires interdependent roles, the Student can learn the specific environmental reference points that function naturally as cues for starting and stopping (e.g., seeing the other children stop and start functions as a cue for the Student’s starting and stopping; partners carry a bag or chest that has two handles – requiring the coordinated starting and stopping of action in order to hold on).

The effectiveness of the Guide depends on providing as many opportunities as possible to work on the skill.  Being able to recognize natural and spontaneous frames for the skill allows Guides to be more effective.

Links:

Guided Participation Menu Card: Articles on Guided Participation teaching and framing techniques http://sponderworks.com/?p=3512

Framing Sheets: These are blank templates that help you organize and plan opportunities that develop a skill.

Examples of Teaching/Skill Frames and the use of Framing Sheets

Framing Sheet Example 1: Spotlight on “Personal Space”

Framing Sheet Example 2: Spotlight on “Prosody”

Framing Sheet Example 3: Spotlight on Topic Changes

How Sensory Integration Dysfunction can lead to Emotional and Behavior Problems Later in Childhood 

In our clinic, we see children as young as 3 or 4 years old beginning to show signs of emotional disorders that are typically seen in children who come from chaotic or abusive families.  But these children come from homes with loving, attuned and responsive parents, plenty of attention, and no history of abandonment, trauma or abuse.  They have well-adjusted siblings.  Parents do everything they can think of to try to help their child – they are far from being distant or neglectful.

Yet these children can be angry at the world, moody, explosive, defiant, inflexible – what many refer to as “emotionally disturbed.” They have difficulty in most or all of their relationships and can be extremely unhappy children, despite having the same advantages as their siblings or any other “successful child.”

Most professionals in the field of mental health, seeing no obvious signs of cognitive or language impairment, will look for signs of abandonment, trauma or abuse, or some form of “deprivation of early empathic care.”  They look for pathological parenting or life experience in other words.  In the worst cases, because professionals may not have experience with Sensory Integration Disorders in early childhood, they may blame the parents and suspect they are not getting the “whole story.”

That part is true – they are not getting the whole story.  The story has to do with how the brain develops in infancy, and the relationship between the sensory, “motor” and emotional parts of the brain to the thinking parts of the brain.

Neurology, Trust and Attachment Security

To paraphrase the late Stanley Greenspan, MD (Greenspan & Weider, 2009), the first developmental achievement or milestone of the newborn is to be able to be calm and interested in the world.  Babies are not born this way – they have to learn how to calm or “soothe” so they can feel comfortable enough to be interested and happy to be in the world.

Newborns have no ability to do this on their own.  They cannot calm themselves down and they get distressed when they are awake and someone or something isn’t around to provide just the right type of stimulation or calming.

Babies experience distress as a normal part of life.  They get hungry, wet, tired, overstimulated, understimulated – there are lots of reasons.  Someone must help them, or their distress will continue to escalate, and if this goes on for long periods and often enough, the brain can suffer catastrophic damage.  Babies can be fed and cleaned in a custodial way, as happens in some orphanages or disturbed families, but there is no relationship between the baby’s needs and the timing of these functions, and stimulation can be too much or too little.  In some cases where only custodial care is provided, babies can still die or “fail to thrive.”  Some will survive, but at great cost to their development, and often with lifetime consequences.

Attuned Parenting

Attuned parenting, or “attunement” refers to the sensitive and responsive nature of meeting a child’s needs.  The attuned Parent responds to the child’s distress in a sensitive way.  The special type of sensitivity that characterizes attunement is based on the Caregiver’s ability to respond quickly enough, and to be able to “read” the baby’s signals.  After all, newborns and infants cannot tell you what they need.  They require someone that cares enough and pays attention in ways that allow them to “learn the baby.”  In the beginning, this can be quite difficult, because babies don’t develop different sounding cries until later.  Therefore, to be an “attuned Caregiver,” you must first be able to figure out the source of the baby’s distress and, you must also be able to do something to relieve the baby’s distress.

In comparison to infants of other species, the human child’s needs are enormously complex.  Sure, it’s pretty easy to figure out if the baby is hungry or wet or uncomfortable, and in those cases, it’s also pretty easy to know how to help.  Those are just the biological basics.

The baby’s sensory and emotional needs are a different matter altogether.  Each baby is different.  Anyone with more than one kid can tell you that.  But all babies need the right amount of stimulation to keep them happy and interested.  Too little, and the baby’s distress comes from not getting enough.  Too much, and the baby’s distress comes from being overwhelmed or overstimulated.  And here, we’re only talking about how much.

Babies also need the right types of stimulation at the right time.  Sometimes they need to be held or bounced or rocked gently.  Sometimes, they need social stimulation such as talking to them, cooing, singing, or smiling and emoting back and forth in a process called “mirroring.”

Parents spend hundreds of hours with their newborns in face-to-face emoting, which all children desperately need for healthy emotional and neurological development thereafter.  It is called “mirroring,” because whether or not they are aware of it (they usually don’t think about it), Parents mirror the expressions of their newborns.  When the baby smiles – they smile.  When the baby belches, they make an “oops” face.  When the baby frowns or shows distress on her face, the attuned Parent has an empathic face.  The Parent therefore is like a mirror of the child’s internal feelings, as they are expressed on the baby’s face.

Emotionally healthy individuals do this in their relationships with others in some way or to some level for the rest of their lives, but at this stage – face-to-face emoting and mirroring is not only the most important form of communication – it is the primary one and the foundation for most further emotional development.  Importantly, it is not mirroring if the parent does not sensitively stay tuned to the baby’s ongoing and changing emotional states and signals.  There must be a certain ongoing synchrony between both the baby’s and the Parent’s internal, subjective, emotional states in order for it to be called “attunement.”

Mutual, Interactive and Dynamic Regulation

Later on, as the baby gets better control of his facial muscles and can produce more stable facial expressions, the mirroring process becomes more of a two-way street.  Now, it isn’t just the parent following the child’s lead.  The baby can follow the Parent’s lead.  The baby can now smile because Mommy or Daddy smiles.  If the parent shows distress, the baby can reflect this.  Each partner now has a “regulatory effect” on the other.  They are responding and changing each other’s emotional states in a “contingent” (I smile then you smile; you frown then I frown) way.  This is what is meant by mutual regulation or “co-regulation.”

Now let us go a little more deeply into what regulation is.  Basically, regulation is the process in which systems achieve stability and control.  Other terms such as balance or homeostasis apply.  We experience good regulation with feeling good (or at least OK), and “dysregulation” as feeling uncomfortable.  Good regulation can exist when we are awake or asleep.  Dysregulation can cause too much waking or too much sleeping, and any number of imbalances.

Our body systems, including our emotional and mental ones, undergo regulation.  We self-regulate by taking care of our needs for nutrition, elimination, stimulation etc.  We regulate each other by performing actions that affect those states in other people.  When people’s actions regulate other people’s actions – we have co-regulation.  The discussion here so far has had to do with the characteristic regulatory needs of newborns and infants in the context of a simple “dyad” with one infant and one parent.  As life progresses, regulation takes on multiple layers of complexity that require the building of ever more complex foundations from this point.  The children that come to the clinic that are labeled “emotionally disturbed” or “autistic” or something else, experience problems with regulation at some level.

The particular types of cases that we are talking about here involve children that had serious trouble with the earliest forms of regulation.  They may have outgrown some of the most obvious forms of infantile chronic distress from Sensory Integration Dysfunction (SID), but the psychological residue remains very present.

Before we get into what that “psychological residue” looks like and how it relates to SID, we should first understand the neurological mechanisms of regulation.

Firstly, the brain and the rest of the body are two parts of the same thing.  Information travels constantly back and forth through all of the parts.  Until we are skilled enough to perform “mind over matter,” the brain and the rest of the body share all aspects of regulation.

Of course, the brain has a special role.  We can exist without arms or legs, but not without a brain.  The brain in fact coordinates the rest of the body’s systems more than any other system regulates the body.

What the Brain Does

The brain does remarkable few things, but in remarkably complex and varied ways.  It interprets what comes into the body in the form of one type of energy or another (e.g., light and from the body as sensation and turns it into perception.  Light waves are eventually “perceived” as vision; sound waves as hearing; chemicals as smell and taste; position or “vestibulation” by virtue of the position of liquid inside the ear; touch by virtue of contact with nerves in the skin; proprioception (the sense of pressure or torque) by virtue of special neurons that sense stretching or compressing, temperature and so on.  The brain also receives input about internal states of hunger, pain, comfort/discomfort, etc.  These constitute the “input” functions of the brain, which end up, once interpreted by several, hierarchically organized sets of neural circuitry - as perception.

The brain also coordinates reactions or movement, which psychologists and medical people call “motor.”  This constitutes the “output” functions of the brain.  “Thought” or thinking is also a motor or output function of the brain, because thoughts are merely movements that we experience inside our heads.

Then there is “attention/memory,” which I combine here because when properly understood, attention and memory are versions of the same thing.  Attention is extremely temporary recall of information, and we usually refer to memory as longer versions of information recall.  When attention is focused on something, whatever it is that we’re attending to activates neural pathways that frame the most current and momentary window of perception.  What we call memory isn’t really like storage – it is more like reactivation of circuits that were first in attention.  Memory is merely reactivation of those pathways back into attention.  I explain how this works in other articles.  For our purposes here (highly simplified), attention/memory is ‘output in search of input.’

So we have basically three things the brain does: input/perception; output/motor and thought, and; attention/memory.  The brain may only do three things, but of course, it does it in enormously varied, complex and exquisite ways.

Synchrony

One of the things that make us human is the power of our brains to coordinate all of the varied input, output and attention/memory mechanisms simultaneously and in parallel fashion.  This is an enormous feat, and we don’t always do it on all levels.  For instance, when we learn a new complex movement such as a dance or driving a car, we can lose track of our surroundings and cut off many other channels of perception and thinking.  When we strain to make out some form of input such as a sound, we are still.

But normally, as we move through the world, our position changes in relation to the objects around us; our weight and balance shift constantly; we maintain trains of thought and execute steps and make the adjustments necessary along the way.  We recall memories (reactivate circuits first formed in attention) to guide our forward thinking.  In other words, input, output, and attention/memory must constantly inform and update each other in order for us to be ‘synced up’ with ourselves and the rest of the world.

The Out of Sync Child

Carol Kranowitz (Kranowitz, 1986) coined this term in her book of the same name about Sensory Processing Dysfunction.  In this paper, I emphasize more than she does the neurological, emotional and behavioral consequences of the disorder later on in childhood and in life in hopes that parents and clinicians may recognize how the psychological and relationship impairments they see actually emanate from developmental, rather than parental pathology.

I cannot describe SID better than Kranowitz, so I quote and paraphrase from her book…

Despite having “…no identified disabilities… [and] they’re healthy, intelligent and loved…they struggle with the basic skills of tolerating ordinary sensations; of planning and organizing their actions; and of regulating their attention and activity levels.”

Kranowitz describes SID briefly as “…the inability to process information through the senses … [which is] …the result of inefficient neurological processing.”  “When a glitch occurs, the brain cannot analyze, organize, and connect – or integrate – sensory messages.  The result of SI Dysfunction is that the child cannot respond to sensory information to behave in a meaningful way, consistent way.  He may also have difficulty using sensory information to plan and organize what he needs to do.”

She describes problems on three different levels: perceptual/input related: difficulties with reading and deciphering patterns in the environment that enable us to find order and a sense of predictability and to get the ‘big picture;’ motor or output related: the child is inflexible and unable to change her behavior or stop herself, and/or; with “facilitation:” “the neurological process that promotes connections between sensory intake and behavioral output.”

Kranowitz connects SID to the emotional and subjective experiences of growing up with it…

“The brain-behavior connection is very strong.  Because the child with SI Dysfunction has a disorganized brain, many aspects of his behavior are disorganized.  His overall development is disorderly and his participation in childhood experiences is spotty, reluctant, or inept.”

I highly recommend reading “The Out of Sync Child.”  It is a seminal contribution to our understanding not only of SI Dysfunction, but also of other disorders that it can lead to such as learning disabilities, autism spectrum and related disorders, mood regulation disorders, etc., as well as the more attachment-related and psychiatric disorders I emphasize here.  Her book is dedicated to understanding the nature and treatment of SI Dysfunction, and she has followed up with various activity books and videos useful for parents and professionals.

“The Out of Sync Child” was originally published in 1986, but since then, neuroscience has developed an enormous body of evidence and a consensus about something called “central coherence” (Frith, 2003) (sometimes called “perception binding” – but central coherence encompasses a lot more) and how the brain organizes information that validates what Kranowitz was saying long before.

Basically, the brain/body sends messages in feedforward and feedback loops to its multitudes of subsystems, in a constant and ongoing (dynamical systems) manner to maintain a coherent and unified experience in the world.  The central nervous system, which coordinates most of it, is made up of hundreds of thousands of circuits that perform separate dedicated functions and that combine with others to perform ever more complex and integrated functions.  For instance, the brain has circuits that may only process a single color; others that see the edges of an object; others that process the motion of it; others that compute its distance or orientation, etc.  These combine to provide a singular visual perception of the object – the visual perception being several steps higher on the hierarchy of perception than its subcomponent circuitry.  Once an object is recognized, other hierarchies of may perceive its function, modulate it so that it does not distort or overwhelm other systems in the brain, record the changes made to it, put it in a context (combine it eventually with other sensory and motor information), etc.  While this description nowhere near does justice to its true complexity, it is apparent that rapid coordinating and updating of each system is vital.

Central coherence has to do with the efficiency of communication and the coalescence between the myriad circuits of the central nervous system.  This is an amazing feat, given that the disparate parts of the brain process different forms of information at different speeds and send their messages across varied distances – and yet still have to function in conditions of constant change.  They say that the brain is a dynamical (multivariate, constantly changing) system that is always on the edge of chaos (the complete breakdown of coherence among the parts).  When each part changes the others have to readjust to maintain synchrony.

And it is not difficult to imagine how “glitches” as Kranowitz calls them can cause disruptions in the larger hierarchies if not the entire system.  The fluidity of simultaneous perception (input) and motor/thought (output) is easily disrupted.  Imagine trying to walk down stairs if the visual system is slow to process depth perception.  Imagine trying to catch a ball or get out of the way of someone walking towards you if your ability to perceive motion is slow.  Imagine talking to someone when your ability to process their words was much slower than your vision.

The Disturbing Nature of being Out of Sync

Not all newborn nervous systems are ready for prime time.  Due to hyper-connection (too much), hypo-connection (too little) or other problems with encoding, modulating and synchronizing one set or level of brain circuitry with another, the infant experiences difficulties managing sensory input – including the feedback he gets from his own movement.  In other words, the baby can be highly disturbed by not being able to filter out or modulate (control registration levels) of input, or the baby may have trouble registering input in order to know how she feels or what is happening.

Babies know when they don’t feel right, and when they don’t they cry out in distress.  This is their natural response.  They don’t know it, but it brings about helping responses in others – that is what it is supposed to do.  Healthy and attuned Caregivers are very “activated” emotionally by a baby’s distress, and have an urgent need to do something about it.  Hence, both parties, baby and Caregiver, experience distress until the baby is relieved or regulated.

As mentioned, in a healthy infant/Parent or Caregiver dyad, this process of regulation, distress and regulation occurs cyclically on a regular basis and is a necessary process for maturing the nervous system.  The baby begins to internalize the process of the autonomic nervous system going up (sympathetic response) and going down (parasympathetic).  Over time, the repeated process creates emotional security and an association between feeling distress, and the presence of a Caregiver being associated with relief and trust.

But what if the baby’s nervous system can’t be relieved? What if the caregiver can’t figure out what is wrong?  Or worse, what if the Caregiver’s actions – even though well meaning – serve to make the baby’s problems worse?  What types of associations do you think the baby will make between feeling distress and the presence of others?  It could be that the baby learns to fear that when he or she feels distress, others will probably make it worse.  As the baby develops abilities to think and assess situations in toddlerhood and early childhood, it can lead to chronic and inchoate feelings of being misunderstood.  As Carol Kranowitz describes, children that experience difficulties with coordinating their responses will also act on impulses or behave in ways that are “too much” or “not enough” and become blamed unfairly – worsening this sense of trust that others understand.

Clinical Example 1

A 12 year old boy demonstrates extreme insecurity, especially regarding his mother.  He expresses it by being extremely clingy around her.  He insists on sleeping in her bed.  He follows her around constantly and always wants to know where she is.  He won’t let her close the door when she goes to the bathroom.  He continues to have serious emotional breakdowns when he has to separate from her, although he tries to act more grown up when in public. 

I got to know this mother.  She was very warm and attuned, and the boy’s older brother and sister were very emotionally healthy, secure, and well behaved.  There was no history of forced separation (as say in hospitalization or loss of a parent’s love), any trauma, abuse or neglect – none of the conditions traditionally associated with creating such insecure attachment.  Both parents were very competent and loving.

So I asked about his early childhood and infancy.  “Oh that first year was awful” remarked his mother.  He would have these long fits of [inconsolable] crying and it seemed there was nothing I could do to help him.  In fact, whatever I tried made it worse.

I asked how the situation resolved.  “I finally figured out – after a year, that it was the refrigerator motor that bothered him.  When it went on, he’d cry.  When it went off – he stopped.”

Think about this.  This mother was always very concerned.  She asked for help and no one could help her.  There was nothing physically wrong with her baby.

This baby went through a year’s worth of un-consoled distress.  At the time when genes in his nervous system were calibrating on the environment for purposes of setting up internal arousal and calming mechanisms – he was constantly overloaded with adrenaline and cortisol.  He was overloaded.  He was ‘drinking out of a sensory fire hose.’

Now think about this.  What do mothers normally do to “soothe” their babies?  They pick them up, bounce them, hold them tightly, sing, talk and coo, rub their backs, etc.  In other words – they provide more sensory input.  A baby that is already overloaded can become further agitated by the mother’s well-meaning actions.  What is she to do – leave him there?  What types of psychological and emotional associations are both parties in the dyad forming?  The baby can come to fear help, and the mother can fear helping.

Clinical Example 2

Sometimes, the opposite can happen.  The baby can only be soothed by the most primitive sensory input – skin-to-skin contact and swaddling.  For generations, we have known that wrapping babies up tightly can help them calm.  Firm touch and holding or swaddling can activate the parasympathetic nervous system (we want hugs and to be held tightly when we experience extreme distress too!). 

In this example, this 9 year old – highly intelligent boy presented as very angry and defiant.  He had been kicked out his school for assaulting children and adults, and he seemed to express no remorse about it.  When interviewed, his mother reported that he could not be calm unless he was on her chest.  The warmth of her body and her heartbeat were the only things that could make him feel OK – for 2 full years!  He couldn’t sleep without her and he was otherwise inconsolable.  At 9 years old, he still couldn’t regulate his arousal.  He was very impulsive and highly reactive to his surroundings.  He was very verbal and obviously very smart, but he couldn’t stick with anything for very long.  Because of his reactive nature, he always got in trouble for impulsive acts like hitting or running away. 

As I got to know him, I found that deep down; he really wanted to be good and to please others.  He just couldn’t fit in and he experienced being in trouble far more than others.  Since he could talk so well and engage in apparently logical reasoning, adults assumed he should “know better” and behave better. 

These are examples of children whose early life experiences were preoccupied with defending themselves against the sensory world and trying to feel OK.  The energy they spent on this made them edgy and irritable and prone to meltdowns.  ‘States’ of arousal eventually become ‘traits.’  Moreover preoccupation with defending themselves against unpredictable and destabilizing stimuli came at the expense of other types of learning experiences that would have taught, or at least allowed them ways to stay calm, in control, and in an optimal state for paying attention and learning.  They missed learning and social experiences that would give them a sense of competence and success.

Because of this they became consumed with feelings (perhaps buried deep below their awareness), that they were never going to be OK.  They continued to experience meltdowns that embarrassed and ashamed them in front of others.  Peers and siblings noticed and judged them harshly or even feared their tempers.  Getting in trouble with adults and other kids and being rejected and avoided by peers only confirmed their doubts.

Oh, they knew the drill.  After getting in trouble for having a tantrum or hitting or breaking something for the umpteenth time, they know what adults need to hear.  The intervening adult (often a parent), has a sound of weary frustration – of ‘here we go again’ and ‘will you ever learn?’ and ‘what is exactly wrong with you anyway?’ attitude that this child has become very sensitized to.

Adult: (Admonishing, frustration-weary tone; disdainful even) “What should you have done?”
Child: [Pick one] “Kept my hands to myself” “Ask permission” “Tell the Teacher” “Watch where I’m going”

This is often followed by “consequences” that are supposed to teach the child not to make the same mistake again.  Or they are dismissed and ridiculed… “It’s just a tag on your shirt.  What is your problem?  You’re just trying to be difficult.”

The saddest part is that these kids want to do well.  At least at first – for their first several years and maybe beyond.  They go out on that playground and they promise themselves, “I am not going to hit anyone today.”  “I’m not going to have a tantrum.”

But someone reaches across them to get a toy and they react reflexively and hit.  Sand gets in their shoes and they explode.  They have too much fun, get too excited, and then they are hyperstimulated and out of control.

They’re wired so tightly.  Those constant rushes of adrenaline in infancy have wired their nervous system to go from 0 to 60 in one second flat.  The adrenaline also stays in their system longer than others (their parasympathetic nervous system is underdeveloped for their needs) so they cannot stop – even when they want to.   The repeated states of fight, freeze or flight have now become ‘most likely responses’ or traits.  They avoid experiences that might make them more resilient or better at self-control and eventually, they are behind in the ability to think before acting and they run through all of the stop signs.  The other kid says, “Stop” and they can’t.  The parent tries to help – and the kid escalates.

The child asks later, “Why didn’t you stop me?”  You respond – “I tried, but you wouldn’t let me.”  Sometimes, trying to stop this child is like stepping in front of a bus.

Back to the Brain

There are good reasons for your child’s current characteristic reactions and ways of handling emotions, even if they have outgrown the obvious signs of sensory processing issues and inconsolability they exhibited earlier on.

This is because the brain is an ‘experience-dependent’ organ.  It requires experience with light and color in order to learn how to see it.  It requires experience with sound in order to learn how to hear, odors in order to learn how to smell and so on.  Each sense requires exposure to its specific stimuli in order to ‘wire up.’  This is called an ‘epigenetic’ process or ‘epigenesis.’

Our DNA only provides us with our genetic potential, not our genetic destiny.  From prenatality to about 2 years old, our brains actually make new neurons (neurogenesis).  By 2 years of age then, all of the cables are provided that we will need for the rest of our lives.  Experience decides which cables to keep, which ones to develop and branch and connect further, and which ones are not needed.

Throughout our lifespan, the brain decides to use the wiring that is already there, and discards a lot of the rest.  Experiences tell us what pathways we will need, which ways to connect them together and use and, which ones to discard or “prune.”  If our brains did not do this (a process called “apoptosis” or “programmed cell death), we would wind up with noisy, inefficiently over-wired brains).  We keep what we need.  This is the reason for instance that people can learn languages well and have perfect accents if they learned the language as children.  In childhood, genes turn on and off pathways that process specific sounds.  If those sounds weren’t in the language you learned as a child – you’ll probably speak with a foreign accent if you learn the language later on.  You never learned to hear the deep subtleties of sound that you are predisposed to learn as children.

Sensory and mood regulation systems work in the same way.  They utilize specific pathways that help us go up and down with our arousal.  Genes turn on and off and pathways are forged by the experiences the brain/body experiences.  Early experiences (and very likely in-utero experiences as well) shape the pathways that will later connect to other systems like the megasystems of pathways that create feelings, emotions, communication and thinking.

I thought it was neurochemistry.  Isn’t that why doctors prescribe medicines for these problems?

Well, it’s about both, because the brain’s pathways also produce the neurochemical messengers that decide where messages go, what thresholds need to be crossed before they will pass along a message, and whether or not to keep using a given pathway.

“Behavioral medicines” – those that influence our moods and behavior, work by changing these thresholds one way or another.  While medicines can be very helpful and lifesaving in some cases, the problem with chemical intervention is that it works on many more pathways than the ones we want them to.  This is why medicines can cause side effects.

Another problem is that medicines really only produce temporary changes.  Indeed, they may allow a child to be more “available” for learning and/or therapy.  Learning and behavioral therapy (therapies that work by interaction between a Therapist and a Patient) create new pathways and may allow the brain to eventually discard some of the problematic old ones.  Another process that actually involves learning is “neurofeedback,” which also changes the wiring of the brain.  Once the wiring is healthier, the neurochemistry is healthier.  This is why it is always best to use learning as the primary force of change, rather than simply medicine.

How Sensory Processing Disorder can predispose a child to emotional problems later on

In order to understand this, we should look at two broad areas: how early experiences affect thinking as thinking becomes part of the child’s mental toolkit, and; how a child’s social experiences – pervasively impacted by SID, can affect their psychological and emotional well-being growing up (I’ve alluded to some of this already).

The Emotional Lava Lamp

From before birth, to neonatality, to infancy, toddlerhood and childhood and beyond, our brains go through the same sequences, different only by degree and type as we go through life.  On the ground floor, we have sensation.  In-utero and neonatal experience teaches the brain to recognize and differentiate sensations.  The primary cables and epigenetic foundations are formed for sensation earliest in life, but we continue to refine our “senses” as we go through life.  For instance, we may be overwhelmed at first by the sensation produced by “hot” pepper.  Taste temporarily highjacks all other systems and one’s conscious attention.  Many of us learn to modulate that sensation to one degree or another, and “acquire a taste” for it.  We’re no longer overwhelmed by reasonable amounts of it, and we may learn to be able to tell one kind of hot pepper from another.  We might do that at any age.

But a sensation – at least neurologically, is mainly a message to the brain that something is there.  The body’s sensors have detected something. It may or may not be important enough to enter conscious attention.  Perception helps us understand what it is.  Perception is the brain’s interpretation of the sensation.  Perception gives us the feeling of what happens as Antonio Damasio, the renowned Neuroscientist and neuroscience popularizer might put it (Damasio, 2000).  Emotions are perceptions of sensations going on in the body and the body’s neurochemical and messengering actions going on.  We perceive a certain wavelength of light as red; a certain molecular structure as the taste of sweetness or a type of odor; changes in infrared radiation as hot or cold, and so on.  We know that dogs do not perceive color but can differentiate and perceive odors much better than we can, and that insects can see more colors than we can, but may not have any awareness or perception of the sensations that light produces in them.  So every animal is different.

Conception is at the top.  Conception is a deep, layered and complex form of perception.  Conception allows us to make associations and to organize perceptions into categories.  Most “higher mammals” can do this.  We are only superior in terms of the degree and scope of our conceptual abilities.  We can label our feelings and we can purposefully communicate our feelings and experiences to others.  We can pick which ones to share and which ones we will [try to] conceal.  We can choose what to respond to, when to respond and how.  We can choose not to respond, which is something even our closest primate relatives have a problem doing.

You can imagine this (and to some degree it is true), that the brain is layered from the bottom to the top in this hierarchy.  While this is almost cartoonishly oversimplified, the bottom deals with sensation, the middle with perception, and the outer layers with conception.  Perhaps the biggest problem with this oversimplification is that it ignores the very real and important fact that our concepts affect the way our senses and perceptions work.  This is why we are affected by optical illusions and that picky eaters can be genuinely disgusted by peas.  Did I mention that shrimps and lobsters are giant sea bugs that if they were found on land might make them unpalatable?  Do you like to eat bacteria?  I do – in some cheeses, breads and wines.

In neonatal development, sensations are just coming into focus.  One of the first motor accomplishments necessary is for the baby to learn how to focus her cornea, because without being able to do that, the most important social stimulus in the world – Mother’s face, is just a blurry set of blobs.  In the first two years, perceptions are forming and memories are being encoded – without language being primarily involved.  Later on, language has a lot to do with how we organize, remember and manage our emotions, but in the first two years, the foundations of all emotional life thereafter are being laid down before language is really useful.

We now understand that emotions are not secondary to language or thinking – they are out in front, in the middle and behind those systems.  Emotions are now recognized as the primary organizers of the brain and no sensation, perception or conception exists without some involvement of emotional pathways.

With sensory integration or sensory processing dysfunction, the neonate/infant/toddler experiences sensations, perceptions (emotions) that lay down pathways and epigenetic instructions that function as records of early life.

As life proceeds, thinking and language develop on top of these layers or experience that were not encoded by linguistic (language) or cognitive (thinking) systems.  These human systems are there to interpret feelings even further and to share them with other parts of our minds and the minds of other people.  Human “thinking” pathways evolved to find causes for things.  When it can’t find the real cause, the thinking brain will make one up.  This is why the Neurolinguist Steven Pinker (Pinker, 2009) has called the cerebral cortex the “[BS]manufacturer.”  Writers like Neurologist Oliver Sacks (Sacks, 1998)and Neuroscientist Vilayanur Ramachandran (Ramachandran, Blakeslee, & Sacks, 1999) describe strange phenomena of patients where the subconscious emotional layers of the brain and the ‘so called’ thinking outer layers are confusing each other and yielding very strange sensations and perceptions of sensory or motor stimuli.

And that is the point.  The inchoate anger, blame, and irritable negative feelings of many children with emotional, behavioral and/or psychiatric disorders do not have to do with the misdeeds of their parents.  They have much to do with their cerebral cortices looking for someone or something to blame for the way they feel and act.

This is why I call this the emotional lava lamp.  Emotions that percolate up to the cerebral cortex from the roiling sea of sensory distorted pathways and memories and expectations underneath manifest as predilections of disturbed thinking and moods.  These pathways have hidden triggers – triggers that were formed before language and thinking pathways were formed to retrieve them.  They are there, but they have very round-about ways of finding their way to the surface, and when they do, the thinking brain has to find a reason and will usually make one up that, well sort of – fits.  “School sucks because it is boring and the Teachers are all stupid.”  “My parents took my cell phone from me at 3 am (not because the texting was keeping me up and is entirely inappropriate anyway), but because they are mean and they don’t love me.”  This is the same kid that might have scored in the Superior Range on the IQ test.

I wrote this article because many parents need to hear this and many professionals need to know this so they can begin to treat the real problem instead of looking for parent pathology that was never there.  If there was maltreatment – it was nature, not nurture.

Adapting – Psychologically
The Emotionally Disturbing Effects of Growing up with SID

How does a 9 year old explain to his friends that he still has [public] meltdowns like a 2 year old?  How can a 4 year old that can hold a conversation like a 7 year old explain to you why he just smashed his little brother’s head into a wall because his little brother touched his blocks?  Why would a 14 year old attack his parents because they would not go out and get another cell phone battery at 1:30 am?  These kids “know better” don’t they?

How can anyone preserve a sense of well-being under such conditions of repeated failure?  How can someone with high intelligence and no excuses (good parents and plenty of chances) manage to preserve the ability to move forward in life?

There are several phenotypical responses that we see.  These responses are the result of the child’s unique neurological issues, the environmental experiences they’ve had, their temperament and cognitive ability and a host of other factors, but they tend to fall into several predictable patterns:

Withdrawal and Depression/Risk Aversion

One way is to simply withdraw.  It is easier to avoid circumstances that could be fun, but that they know carry the risk of potential breakdown and public humiliation.  They learn to play alone and to stick to the familiar.  They trust fewer people and increasingly restrict their lives.  They are consumed with shame and doubt.  They may even avoid parents and family that see them as spoiled.  Their parents also can become isolated, because there are others that see the child that way.  Parents regularly get recommendations to spank and punish the problem away.  Many parents have already tried that, and not only did it not work, it further eroded what little trust the child had left and made the parent feel even more like a failure.

Aggressive; Defiant; Externalized and “Owning it”

Some kids don’t want to go away.  But how do they explain their behavior.  “Why did you hit?”  “Uh, I meant to…yeah, that’s it.  I meant to do it and I’ll do it again.”  Psychologically, it is easier to tell yourself that you are in control of your behavior than to face the fact that maybe you’re not.  Instead of collapsing into a heap, they aggress.

Younger children are also magical thinkers.  ‘The reason I hit that other kid was because he touched my toy.’  They begin to blame others.  They blame their parents for not being able to prevent this from happening to them (after all – it feels out of control; it feels that it is happening to them and they do not have control.  And to a large extent – a young child doesn’t really have the capacity to stop).  When a shirt itches too much and it triggers a hard-wired explosive response – the child blames the parent and punishes them – no matter how loving, patient and attuned that parent tries to be.  “You put that shirt on me.  You should have known it was gonna itch.  It’s your fault.”

Inflexible; Controlling

Living with a nervous system that can fail at any time and result in catastrophic meltdown leads one to avoid uncertainty.  These kids want to know everything before it happens.  Parents preview upcoming events extensively.  They play alone or they play with younger children so they can be in control of events.  No surprises.  Surprises require quick processing and fluid adapting – and this is exactly what this child wants to avoid.

Clingy

This may seem paradoxical.  The child that could not be soothed has now become insecurely attached to a parent – usually the mother.  This is the same mother that during infancy, well meaning – still blew up the child every time she tried to help.  Now, he clings to her for dear life.  Why?

One reason is that no one else is going to stick around unconditionally.  Our species seems to be hard-wired to expect our mothers to put up with us no matter what.  We will work hard to stay in control for periods of time when we are around peers and others that will reject us – but we let it all hang out with our mothers.  “Why am I the punching bag?” mothers ask.  “Who else would it be?” seems to be the answer.

Angry/Ambivalent

By any stretch of the imagination – this life circumstance is incredibly unfair.  Not only is the sensory world disturbingly uncomfortable and potentially unraveling, impulses and losses of control lead to repeated humiliation, shame, rejection, punishment, and finally erosion of self-esteem and growing self-doubt.  The future is not something to look forward to.  It just seems to get worse.  No one understands and people are starting to hate me.  Other kids think I’m crazy.  I don’t want to go back to school.  I don’t want to go to parties anymore.  I can’t do fun stuff.

Here again, who’s going to sit around and take the brunt of the anger?  Parents – especially mothers.  Perhaps a few caring and understanding professionals committed to help – if you can find them.  Most just blame (see the October 10, 2011 story in the Los Angeles Times[1]), and the child risks being constantly punished, restricted, or even expelled from school.

Other Maladaptations

Punishment works – in the short term.  “Knock it off or I’ll give you something to cry about!”  This is like squeezing a balloon.   Suppress one behavior and it pops up as another.  The anger goes underground and becomes internalized.  The behavior of the moment will stop – in the presence of the punisher – that is a cardinal rule of how punishment works.  And punishment, in order to remain effective – usually has to be continually escalated.  And when you’ve gone as far as you can morally handle – then what do you do?

What happens with suppression is that the behavior goes underground and resurfaces in damaging ways.  Some kids will seek punishing or degrading experiences or self-mutilate to mask their pain.  Others will turn to drugs to manage their feelings.  There are few good outcomes to punishment as an approach to this problem.

Rewards for good behavior can be even worse.  These kids are notorious for ripping up their sticker charts.  They want to be good, but they fail because their nervous systems are like minefields.  It’s like asking someone to stop hiccupping – for a reward.  Carol Kranowitz describes these children as having “indigestion of the brain.”  It is a physical, physiological problem.  There aren’t enough stickers to make this stop.  And fairly soon, these kids can smell a naïve professional with a sticker chart in her hand – and rarely is the outcome very good.  These kids need professionals that know what they’re doing and that do not assume that what works with other kids will work with these kids.

What you’ll never hear

Please – if there is any professional or parent out there that has heard their child or adolescent say, “I experience emotions that really have their roots in infancy and my history with sensorimotor processing dysfunction and the reason I came for counseling is because I want to stop blaming my the people that love and care for me unfairly…” please let me know.

What you typically hear

I usually want to know what the child thinks when he comes to the clinic.  I want to know the child’s perception of why he was brought to counseling.

Those of us that work with children know that the children themselves usually don’t know why they are in counseling or what counseling really is or is supposed to accomplish.  This is a fundamental difference between working with children – who usually do not come voluntarily, and adults that seek out psychotherapeutic help.  Adults have some sense of their failure or they want to know why everyone else fails them, and they often have a perception of the impact their moods and behavior has in their lives.

The answers I get from children when I ask them why they think their parents or school brought them in often reveal their psychological adaptation to their reality.  Often, the answer is “I don’t know,” which can be in large part true, and in many cases – not true.  Some will say, “Because they think I’m crazy” “I’m crazy” “I’m bad” “I hit people” “I don’t want to go to school” “I’m stupid” “The other kids won’t play with me” “They don’t like me” etc.

Advice to Professionals

Mental health professionals that work with children have brains that work like everyone else’s.  They tend to see what they expect to see.  The have their own professional development experiences that shape their thinking.

My own strange professional journey is like the bowling ball going down the bowling alley with the bumpers in the gutters, bouncing back and forth between behavioral and developmental and psychodynamic orientations.  On my way, I’ve had both the privilege or working with professionals from many schools of thought, and the intense annoyance of dealing professionals that are religiously tied to one school of thought.  This accounts for my orthodox agnosticism, and perhaps my immodest claim to be able to write this article.

Those with behavioral orientations look at the child’s experiences and the learning that resulted.  They will often miss the sensory and neurological underpinnings of the problem, and wrongly assume that these children come from pathological environments. They do not usually take early developmental histories and rarely ask questions about early sensory and arousal/mood regulation.  They usually do ask about early behaviors and how the parents handled them, and yes, parents often end up mishandling the behaviors.

But far too often, I have seen parents blamed unfairly by professionals that do not understand the peculiar evolution from SID to Emotional or Psychiatric disturbances of later childhood.  This is especially true if they work in clinics that deal with children diagnosed with Conduct Disorders, Oppositional Defiance, or in schools where kids are lumped together in a category called “emotionally disturbed.”  The cerebral cortices of these professionals will manufacture parent pathology that wasn’t there in the beginning.   Parent pathology may indeed form later on as the result of living with these children and being punished constantly by their kids and the professionals whose “help” they seek.  Some have had their children manipulate the system and have called child abuse hotlines to report abuse – just to punish their parents for taking their cell phones.  Imagine trying to keep loving a child through that.  What is amazing to me is how emotionally healthy and resilient many parents are – especially when around professionals that are not in the act of blaming them.

Professionals with developmental orientations will recognize and deal with the sensory issues – but they often don’t see these kids.  They see the kids with autism and developmental delays.  Counseling is not their “go to” intervention.  The “talking cure” is not their specialty.  They may attribute too much to neurology and sensory development, and work that angle – if they ever get to treat a child diagnosed with Conduct Disorder or Emotional Disturbance.  Or, they may use Applied Behavior Analytic (ABA) treatments, which I think can be totally inappropriate.

School professionals can take an “either/or” orientation.  Either these children are emotional disturbed (connoting parent/environmental pathology, or perhaps organic psychiatric pathology such as ADHD, Schizophrenic, Bipolar or Obsessive/Compulsive disorder), or, they are autistic and they’re thought to belong in the autism classroom – where their patterns of thinking and feeling rarely come under study or treatment.  The former is more often the case, because the child that curses and accuses and speaks above his age level is probably not headed for the autism classroom.  Asperger’s Syndrome is now widely recognized, and many can be misdiagnosed with AS.  All of the above diagnoses can share a history of SID, but the evolutionary outcome is different.  These kids are experiencing sociopathy.  And unfortunately, the pervasive influence of ABA in Special Education precludes the necessary psychodynamic orientation I think is necessary in treating these children.

For professionals, I recommend what I consider to be a definitive book on Conduct Disorders that recognizes the interaction between children’s sensory makeup and temperament and that of parents written by Pauline Kernberg and Saralea Chazan. (Kernberg & Chazan, 1991).

Conclusion

This article was meant to provide background and understanding, mainly to prevent good parents from being blamed for childhood conditions that are otherwise typically caused by pathological environments, parenting and child maltreatment.

I will follow up on Treatment Recommendations from experts that I believe have the appropriate understanding of both the neurodevelopmental, psychodynamic, and environmental complexities of the issue.

Sources:

Damasio, A. (2000). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. Mariner Books.

Frith, U. (2003). Autism: Explaining the Enigma (Cognitive Development) (2 ed.). Wiley-Blackwell.

Greenspan, S., & Weider, S. (2009). Engaging Autism: Using the Floor Time Approach to Help Children Relate, Communicate, and Think. Da Capo Lifelong Books.

Kernberg, P., & Chazan, S. (1991). Children with Conduct Disorders. USA: Basic Books.

Kranowitz, C. (1986). The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction. New York, N.Y.: Perigree.

Pinker, S. (2009). How the Mind Works (Reissue edition ed.). W. W. Norton & Company.

Ramachandran, V. S., Blakeslee, S., & Sacks, O. (1999). Phantoms in the Brain: Probing the Mysteries of the Human Mind . Harper Perennial .

Roan, S. (2011, October 10). Child Mental Disorders: New diagnosis or another dilemma. Los Angeles Times.

Sacks, O. (1998). The Man Who Mistook His Wife For A Hat: And Other Clinical Tales . Touchstone.

 

 

 

 

 

Assessment of Motor/Orthopedic Conditions

Describe major motor impairments, because by definition they are likely to affect the total behavioral constellation of an individual. Describe even minor motor impairment if it is related to the referral concerns. Here are some ways in which we have seen motor impairments affect development in other domains:

Parental Difficulties with Setting Expectations

When a child is born with obvious motor impairments such as cerebral palsy (below), parents are confronted with questions of how much to expect in the way of their child’s independence and desire for independence. Chances are (and remember – ultimate effects are the result of temperament and other factors as well), that setting expectations too low can lead to unnecessary helplessness and dependence, while setting them too high can lead to frustration and discouragement.

Difficulty in setting expectation is inherent with any developmental difference. When you think about it, setting expectations is a difficult enough task with any Guide. Guides of neurotypical children can differ quite a bit in their expectations of normal function – and the results of overestimation and underestimation can be the same (although usually not to the pervasive degree seen in disabling conditions).

Disabling conditions of any kind confuse the developmental picture even further. Go to the bookstore and you will see rows of books on raising children and “What to Expect…” A developmental disorder on the other hand is unique to every individual – every person with a disability has a different profile. Even when books refer to specific diagnoses such as Autism, ADD, Cerebral Palsy etc., they are describing very heterogeneous within-diagnosis populations.

Learned Helplessness

Perhaps the most significant factor to analyze when motor impairments are present is how they affect the IP’s desire for independence (and sometimes thGuides’ desire for their IP’s independence).

Difficulties with movement are likely to have started before birth,[27] making it difficult for the Student to accomplish the simplest movements and coordination between the senses and movement. This affects the IP’s expectations of him or herself – even before interactions begin with the external world.  Parental underestimation can further compound the emotional affects of a motor impairment – leading them to do for the IP what might be healthier for the IP to do for him or herself.

Over time, patterns of dependence can take on secondary functions for individuals in the relationship.  A person can grow afraid of frustration to the point where they grossly underestimate their own abilities and refuse to do things for themselves. Guides can reinforce this when they offer care too quickly, or when their anxious emotional signals lead to similar, resonant reactions in the IP. By offering care too quickly (whether by necessity of time, basic belief about the level of true impact of the disability, or to avoid their own anxieties related to these things) – they deprive the IP of the chance to develop a tolerance for frustration and to experience new levels of function.

Guides can also become wedded to the caregiving role far beyond the level of care that is necessary. Caregiving can take on an overly defining role in the Guide’s self-concept, and the Gide can become unhealthily invested in the IP’s disability. Such a Guide can view steps towards independence as threatening, and tend to [consciously or unconsciously] sabotage the IP’s initiative. This is a very important thing to notice when it is present.

Understimulation/Hypotonia

The more obvious signs of motor coordination delays are very often accompanied with muscle weakness, low muscle tone, and “under-registration” of tactile, proprioceptive, and/or vestibular input.

These symptoms are also highly correlated with problems regulating arousal. IP’s that under-register sensory input (in general, but especially with motor/proprio-/vestibular channels) can be hypoaroused (under-alert, spacey, distractible, sleepy, etc.), or hyperaroused (sensory seeking: hyperactive, impulsive, or, rigid, anxious, etc.).

Lack of Exploration and/or Persistence

The pattern of behavior most often associated observed in motor-impaired children has to do with a lack of interest in the environment and a tendency to terminate exploration almost as soon as frustration occurs.

Neurotypical children without motor impairments should be aggressive explorers of their environment. They are driven in a way to act upon objects and with people in order to learn from them. Throughout these interactions with objects and people, there are enough successes to encourage the child through a lifetime of exploration. Constant experimentation leads to further interest, which leads to further exploration, etc.  Feelings of competence lead a person to prefer variety and novelty, rather than sameness.

Motor impairments affect an IP’s feelings of competence adversely, often leading to a lack of exploration. A history of frustration can lead to a “learned disinterest,” or even an aversion to interacting with objects.

Over time, this results in delays in cognitive skills that might not otherwise happen. More specifically, the IP whose motor coordination difficulties are an ever-present obstacle lacks practice and development of means of exploration that would lead to further learning. Furthermore, a history of frustration teaches a person that persistence is pointless or even disastrous, which in turn leads to less than necessary levels of persistence and problem solving efforts.

Fleeting Attention

In the brain, perception and action are intertwined. Thoughts and the focusing and refocusing of attention are internalized motor actions (see below: Thinking, Memory, and Anticipation as internalized motor action). Attention also involves [physical] ocular-motor and pupillary actions).

The coordination of the head, eyes, and neck is one of the first things an infant learns. This begins the person’s life-long journey of exploration. In other words, the coordination of the head, eyes, and neck is among the first means of exploration to develop. At this stage, children learn to shift and set their focus on interesting things, and to maintain their attention for increasingly longer periods of time. Over time, as available mental real-estate (synapses) grows and increased capacity for memory results, the child learns to improvise, remember and anticipate sequences and problem-solving steps (“sequential thinking,” “sequential memory”).

As the IP accumulates experience, he or she acquires greater capacity to improvise, remember, and anticipate longer sequences. However, if development proceeds with a significant lack of experience with objects or people, then there is typically a correlated lack of ability to maintain focus on objects or people.

Finally, knowledge primes attention. That is, we are more likely to become and stay interested in things in which we have some knowledge or familiarity. A Student might find it difficult to become interested in things in which he has no experience.

Proprioception and Toilet Training

The sense of bladder or bowel fullness is conveyed to the brain by proprioceptors in the bladder or bowel wall. These proprioceptors convey a sense of fullness when they are distended (stretched).

As in all perception, proprioception occurs in the brain. Delays in proprioception are evident in a variety of neurodevelopmental and neurodegenerative (e.g., Alzheimer’s, Parkinson’s, etc.) disorders. A Student’s under-registration of proprioceptive input can be an obstacle to continence and toilet learning. Therefore, signs and reports of diminished proprioception, hypotonia (low [muscle] tone resulting from inadequate muscle innervation), arousal dysregulation, and other motor-muscular-perception-arousal axis symptoms can be identified as setting conditions related to problems in toilet learning.

Trunk Control

Toilet learning problems are also found in children who have had a history of severe movement-coordination and muscle tone developmental delays.

Note that young NT children (18 months to 3 years on average – who are aware of the somatic signals of bowel or bladder fullness, and who have sphincter control), will often find a private place to have a bowel movement.

When they do this, note that they often have their bowel movements in a standing position (they might lean on something – but they remain upright). Toilet teaching requires a Student to be able to have a bowel movement in a folded position, which can be difficult or impossible for a severely hypotonic Student.

Thinking, Memory, and Anticipation as Internalized Motor Actions

Advances in the mammalian, primate, and then human brains – the neocortex, enabled higher animals to “store” motor actions at least temporarily before executing them. Behavior then evolved from reflexive or stereotyped (“fixed”) action patterns into increased ability to select from “behavioral options.” Anything that can be considered a neurobehavioral option is an entity that is somehow stored in the brain and not yet executed.

Any observable movement is the result of a sequence of neural firings to the muscles involved (a motor program, motor routine, or motor plan – depending upon who is describing it). Even the simpler steps of complex movements consist of an encapsulation of a serious of “bursts” to individual muscle groups. The seeming smooth extension of the arm to reach for something can consist of thousands of these bursts, executed in fine sequence. Such simple behaviors such as taking a step or reaching or extending one’s tongue are loaded into a buffer prior to being executed one by one in sequence.

For the reptile, all behaviors are stereotyped. That is, in reaction to a stimulus, a behavioral sequence – one largely inherited and not subject to environmental shaping or learning, is loaded into the buffer a split second before it is executed. There is no other structure in the reptile’s brain that can stop it once it is activated. The buffer only holds the sequence so the individual bursts can be sequentially executed.

Mammals have the ability to inhibit their behavioral responses. They can have the intent to do something (the behavior is planned and loaded), but for some reason, the animal can choose not to execute the behavior. The animal can stop or reverse behavioral course.

Developmentally mature humans have additional abilities. Not only do they have the ability to select from behavioral options, they can “imagine” behaviors by running the sequences internally. This is experienced as “seeing it in one’s mind.” This can be done in the auditory mode when it comes to remembering something one has heard, such as a conversation or melody.

Implicit v. Explicit Memory

Very briefly, implicit memory is for “knowing how,” whereas explicit memory is for “knowing what.” Explicit memory is available to consciousness: one can think about facts and experiences; whereas implicit memory is not available to consciousness.

For instance, walking (for those who have mastered walking to the point where it is no longer “thought about”) is a procedure that was learned at one time through repetition, and cannot be adequately described in terms of conscious, explicit thinking. In other words, you cannot explain how to walk completely. You might be able to describe the movements, and you can get into great detail regard the kinesiology involved, but you can not describe how it feels to walk and what to do in terms of the millions of calculations involved as the body continuously rebalances itself and moves forward.

Why do we need to know this? For our purposes, it is very important to understand the process of learning and how learned content becomes memory, and how sensorimotor acquisition becomes working memory, short-term memory, and long term memory. One of the core deficits of autism is difficulty acquiring perceptions and coordinating actions in a coherent, synchronized way, which causes people with autism to think about their perceptions and actions on a conscious level. This in turn, deprives them of available working memory that could be used to focus on the external world.

Sensorimotor Learning

Sensory memory is memory that forms from the moment a stimulus is perceived. This form of memory enables the mind to hold on to sensory perceptions for brief moments in order to guide motor action and thinking. Individual sensory memory systems act as buffers for information received through their respective channels, and attention filters out the interesting and/or relevant stimuli and routes it to short-term memory.[28]

Motor Action

Sensory perception provides feedback for the actions the body takes. There is a continuous loop: perception guides the next movement, the movement is experienced through the open sensory channels, which in turn guides the adjustment or next motor movement.

Sensorimotor learning therefore, is a form of learning where the information coming through the senses occupies the majority of working memory. It is necessary in order to master physical actions (including speaking), but it is not a good condition for social learning.

We never graduate completely form sensorimotor learning. For a lot of things, especially with those skills that require physical interaction with an object, our first attempts at learning require most of our conscious attention:

Example

Think about learning how to drive a stick-shifted car. In your first attempts at learning, all you can really think about are the sensory perceptions and physical (motor) actions you are doing. You’re concentrating on the feeling of the clutch under your left foot and how hard you have to press down on the shifter to shift gears with your right hand. You are consciously searching your memory to remember the gear patterns.

The total of these activities occupy you almost completely. If someone were to turn on the radio or try to have a conversation with you about another topic, you would probably find that quite disconcerting.

The above is a good description of the sensory/motor learning style and experience. The sensory and motor experiences/perceptions occupy the vast majority of available working memory. That is why the learning or cognitive processing involved, the memories involved, are termed “explicit memory.” The thinking is explicit, out in the open and available for self-examination.

As you might expect with the stick-shift example above, repeated practice results in what we often called “second-nature” in the vernacular. We no longer have to think about the actions very much, and they seem to go on at some other level of consciousness.

This is because they are going on at a different level of thinking and memory. Sensory and motor experiences that go through the process of overlearning become “decorticated,” that is, they become under the control of older, subconscious parts of the brain near the brain stem and spinal cord. Decortication is the process of moving thinking from the newer and higher-thinking parts of the cerebral cortex to brainstem and spinal mechanisms that can run them as subconscious routines. Here are some subconscious routines we all have by maturity:

Sitting up
Walking
Talking
Tying shoes
Writing your name
Using a fork

These are pretty obvious examples. I put “using a fork” last, because if most of us Westerners think about using chopsticks, we’re still somewhat sensorimotor with them – in other words – they require conscious thinking and use up working memory. This of course would not be true for someone who uses chopsticks enough to not have to think about it.

There was a time when you did have to think about these things – but you don’t remember it. Watching infants closely, one can see what a challenge learning to sit up, balance, walk, etc. these very basic skills are when they’re developing. One can also see how mastery of these skills requires less and less of their conscious attention. This process allows for instance, the child who has mastered sitting up to take in the world a new way: to see further, to reach and grab with arms that are now free. Instead of focusing on sitting up, the child focuses on her surroundings and explores from her new position and vantage point. This process occurs for every newly acquired motor skill throughout life, given sufficient repetition.

Working Memory

Working memory is a temporary form of memory that guides action. Working memory has been called the “mental sketchpad” or on-line” memory. It keeps information only long enough until we need to use it. It is continuously updated and available to conscious memory.

The contents of long term declarative memories (things we can consciously remember) can also be loaded into the working memory “buffer,” to guide actions as well. Here are some applications of WM that might be relevant:

Remembering what someone said in order to follow a direction
Remembering rules
Remembering what others have said or done while thinking of what to do next in a fluid social situation.

Short-Term Memory

Working memory is defined as the structures and processes used for temporarily storing and manipulating information, while short-term memory generally refers only to the storage structures involved. Thus, short-term memory can be considered a subset of working memory

Perception and Action

It is also important to realize that there is no action without perception, and there is no perception without action. The two are not only intertwined; at the neural level, they are merely flip sides of the same coin. Perception and action are different aspects of the same thing. For instance, in the act of walking, the brain is constantly monitoring the body’s shifting weight from top to bottom, side to side, forwards and back. Hundreds of thousands of signals are sent to the brain, and actions are coordinated in response without thinking.

Sensorimotor learning and resulting decortification, transfer actions that have been learned/remembered into a form of memory called ‘implicit memory.’

Forms of Memory Defined

Implicit Memory

This is a form of long-term memory that has to do with anything remembered at the unconscious level (where the memory is not available to consciousness – even with efforts to recall them). This form of memory is not available to consciousness and cannot be consciously recalled.

One form of implicit memory is called “procedural memory,” which occurs when learning is transferred to brain stem (basal ganglia) and cerebellar mechanisms that run motor sequences in a somewhat automatic way. Procedural memory is almost exclusively talked about in terms of motor actions, but if thought is really internalized motor actions, than it is possible that recurrent thoughts can also be governed by procedural mechanisms.

Another form of implicit memory has to do with remembering the emotions of an event, but not being able to remember the event. This might seem odd, but it is what occurs in young children, especially before they learn language. They have very poor or absent memories of what happened, but an unconscious association between stimulus and emotional memory occurs. This can lead individuals of any age to feel a certain way in the presence of certain stimuli – without knowing why they feel that way.

Explicit or Declarative Memory

This is a form of long-term memory that is available to consciousness, and requires conscious recall to be activated – hence the term ‘explicit.’ There are two forms of declarative memory: Semantic Memory and Episodic Memory. These two forms of memory use vastly different neural mechanisms, and more importantly: episodic memory is significantly impaired in autism; whereas semantic memory is often not significantly impaired.

Semantic memory

Semantic memory has to do with remembering static facts that are independent of context. People with PDDs can have relatively well-developed semantic memory, because the content of this form of memory is most static. For instance, people’s names and birthdates don’t change, Sacramento is the capital of California, Abraham Lincoln will always be the 16^th President, and so on.

Episodic Memory

This has to do with the encoding of personal experience – the perceptions, sensations, the personal meaning of episodes.

People with PDDs tend to view the world through a key-hole. That is, they tend to favor in a lopsided way certain sensory channels over others. They often close off some sensory channels completely in order to concentrate on a single one (either looking or listening, but not both at the same time). As a result, personal experiences are encoded in a fragmented or one-dimensional way.

Furthermore, experiences and perceptions tend to be encoded in a static manner. Keep in mind that a personal experience is a dynamic one. It is a movie, not a photograph. It is a conversation, not a tape. The perceptions of a personal episode are constantly changing, and working memory has to be constantly updated in order to track the changes. There are usually problems with working memory capacity in all developmental disorders, usually associated with transfer of memory from one memory type to another.

This form of memory is autobiographical – the memory of personal experiences, which is the foundation for sharing experiences with others, perspective-taking, and empathy.

It is very important look at intervention programs in terms of their emphasis on either semantic (static) or episodic memory. It can be quite impressive when an IP who previously showed little in the way of organized learning to be able to label objects and people, play with toys “correctly,” learn their colors, shapes, numbers; to learn reading decoding, and even to be able to learn so-called “pragmatic” social language skills (e.g. greetings, social scripts, manners, turn-taking, etc.) and to label feelings.[29] However, intervention that focuses exclusively on these skills (that are much easier to teach to children with PDDs because of their relative strengths in semantic memory) and ignores an equal or greater emphasis on episodic memory does nothing to remediate the core deficits of their disability. The result is typically a more knowledgeable, but no less autistic individual.

Forethought

Internal seeing and hearing are the only senses that we can conjure up at will – that is – we can conjure up a fairly rich representation of the perception in consciousness without the stimulus having to be present.[30] This allows us to rehearse and modify behavior in our minds the way no other animal can.

I say that developmentally mature humans can do this, because very young children cannot. Because the frontal and orbitofrontal lobes of the brain are not mature before 18-24 months or so, infants and toddlers have little in the way of short-term memory, and are somewhat dependent upon the continued presence of stimuli in order to create internal mental “pictures” or sounds. For this reason, they are distracted easily.

Because of the short-term memory capacity problem, children have trouble remembering rules and ideas especially when there is a competing – “in the present” stimulus.

Little Nicholas (18 months), is adamant that he wants to play with the clock on the dresser. He reaches for it; Mom says, “Don’t touch,” and Nicholas protests. He keeps trying, and Mom repeats herself several times. Finally, Mom takes Nicholas to the play room and gives him the bubble lawn mower. He immediately started to play with it, apparently having forgotten the clock.

Mom took advantage of the fact Nicholas doesn’t have a real extensive working memory. For the most part, changing the scenery took care of the problem, because at this stage, his frontal lobes have only begun to mature to the point where information can be retained in consciousness.[31] There isn’t much room, and the only thing that can occupy Nicholas’s consciousness at his age is one idea – almost always – the thing that is present.

Austin…
20-month-old Austin has discovered the entertainment system in the living room. The buttons of the TV were right at eye-level for him – and were practically irresistible. He pushed the button and the TV turned on. He pushed it again and it went off. He did it over and over with great fascination. Mom said, “Don’t touch,” and Austin stopped.

Austin usually tries to please his Teacher. After Austin complied, Mom went on with what she was doing. So did Austin. Even though Mom and Austin were in the same room together and Mom could see him constantly, Austin went right back to the button as soon as he turned around and saw it again. Mom repeated, “Austin, “No, No.” Austin complied – he stopped for a few seconds and went on to do something else.

It happened again within 5 minutes. Austin saw the button, and started pushing the button again. This time, Mommy was getting a little ticked, and said more sharply, “Austin NO!” Austin recoiled this time.

2 minutes pass, Austin toddles past the TV, and it happened AGAIN.

Austin also has trouble keeping more than one idea in his mind at once. For him, it was either the admonition not to touch, or the button – but not both. He has real trouble seeing the button, and experiencing all of the positive and motivating motions that come with that, AND remembering what his Teacher told him.

After about a dozen times, Austin is beginning to operate from working memory. He makes several more passes by the button, looks at his Mom, and actually inhibits himself. Viola!

The same thing happened again the next day. Mom was talking to Dad for a moment and Austin did it again! “Austin, NO!” Austin reels backward and cries. He was genuinely surprised by Mom’s reaction. Exasperated, Mom says to Dad, “He knows better.”

Well, sort of. When Mom makes eye-contact with him and both of their attention joins on the TV, Austin recalls Mom’s rule.[32] With periodic reminders, he can stay away from the button, and with consistent repetition, he can stay away from that TV.

Inhibition

Inhibiting a potential motor action (e.g., reaching for the button), is a first step towards working memory, but more importantly: development of the ability to think about (or plan) an action and not do it.

As the brain grows and reorganizes (especially the frontal cortices), there is more mental real estate (synapses) available to hold memory – at least temporarily. When this happens, something developmental psychologists call “forethought” is possible. You can see it in the way a Student solves a problem. They begin to go from random actions on objects and with people to more purposeful actions. They are able to think about what they’re going to do – before they do it – suggesting the ability to hold an idea in mind while they are performing steps.

Assessment of Social Skills

Social Cognition

Social cognitive thinking has to do with the ability to perceive one’s own mind and the minds of others. It has to do with the observing self – the ability to recognize one’s own behavior and what it means.[26]

Social cognition also has to do with perceiving others’ behavior and what that means. This involves to a large extent interpreting the emotional signals of others moment to moment – the essence of dynamic social functioning (see Dynamic Systems, above).

And finally, it has to do with knowledge of what other people know, their beliefs, and how they’re likely to be feeling.

Theory of Mind

“Theory of Mind” has mainly to do with how the IP tracks ‘minds.’  In a classic experiment, the IP observes her mother put a candy bar in a drawer. Mother then leaves the room. Once she’s gone, the experimenter moves the candy bar to another (2^nd) drawer and then asks the IP, “Where will Mommy look for the candy bar?”  The IP who lacks this basic level of theory of mind will point to the 2^nd drawer.

Knowledge is only one hidden mental component — belief is another. In one situation, a person might see the Student but believe that the Student is waving their toy out of fun, in another, to get their attention. As in the above situation two physically equivalent situations exist that both give rise to two different responses: in one the adult ignores them, and in the other they stop and play.

A further hidden mental component is desire. Consider, for instance, one situation where an adult is tired with playing with the Student, contrasted with another, where this is still a source of enjoyment. Here again, we have two equivalent situations into which a Student emits the same behavior but gets two different reactions, in one the adult makes a moan of ‘not again,’ and in the other they stop and join them.

What these examples show is that children must uncover the existence of hidden components — a person’s knowledge, beliefs and desires — if they are to understand how that person reacts to them. Much fragmentary information exists around them that can be used to do this. Though the initial situations have been described as equivalent they, of course, are not.

In the first, a slight difference exists in the position of the adult that enables them to see or not see the Student.

In the second, a history of encounters between the adult and the Student exist such as to give grounds for the adult to believe that the Student enjoys waving the toy (in the manner in which they have done) vs. waving the toy to get attention.

In the third, a history exists of how the adult reacts to the attempts of the Student to get their attention to play with them.

Thus the hidden mental components in these equivalent situations are detectable provided a Student possesses models that enable them to predict the interactions of their actions with a person’s knowledge, beliefs and desires. If so, the Student is set up with models as to what the adult knows, believes and desires in relation to their actions. Further, it is set up to engage in what might called ‘forensic cognition’ so that it can keep such models up to date by being highly sensitive to the subtle cues and inferences that indicate changes occurring in the hidden state of the other’s mind.

Social Interaction with Adults other than Attachment Figures

This has to do with how far the IP’scircles of care extend. Think of concentric circles:

Concentric Circles of Care

As a IP develops means (universal enough) to communicate with unfamiliar people, and has also developed means of communicating details of events outside of the here and now, he or she becomes ready and able to take part in groups that are increasingly distant from the caregiver.  In contrast, the IP whose communication is difficult to interpret, or whose ability to read the emotional and communicative signals of only the most familiar caregivers – feels very vulnerable under the care of others. This can be seen in the light of developmental age. Once the IP has developed stranger anxiety (around 8 or 9 months), she becomes reluctant to spend time outside the immediate proximity of caregivers.

Interaction with Siblings/Peers

This is particularly important when the referral issues concern sibling or peer play and conflict.  Otherwise, a lengthy discussion here would likely be redundant with the means of emotional problem solving and play sections below.

Here are a few generalized characteristics of sibling relationships you can use to describe them:

Indifferent

Siblings have almost nothing to do with the client. Interactions tend to be brief, intermittent, instrumental, or even hostile. Siblings might prefer to go directly to the adult without even trying to interact directly with the Student (e.g., “Mom, Jenna ate took my Barbie!”).

Caretaking

Siblings see themselves as support for the Guides, and much of their interaction with the sibling concerns supervision, assistance, entertaining, etc. – much like what the Guides do. This is not unusual as time goes on and the difference between the developmental age of the client and his siblings grows larger.

Comment on the rare case when the sibling has too much (inappropriate levels of) responsibility. This of course is relative to the age of the sibling. Some siblings are adults themselves or older teenagers, and the level of supervision they have is commensurate with their capacity and willingness to care for the client.

Conflicted

Conflict is a predominant feature of the sibling relationship(s).

Caring for a disabled person tends to usurp time and energy that could be more evenly distributed among siblings and spouses. People with disabilities can have much more in the way of doctor appointments, therapy appointments, and other obligations inside and outside the home, as well as possibly extensive behavioral needs and a prolonged extension of levels of care and supervision expected with very young children. This is one reason we put emphasis on the analysis of caregiving arrangements and support.

When such a lopsided caregiving situation exists, certain effects can be anticipated over a period of time. The first has to do with parental anxieties. Not only do Caregivers wonder and fear for what would happen to the disabled person if something were to happen to them, they acknowledge that one individual (the IP) receives the vast majority of their energy and attention – and they worry how it affects their other children.  This further debilitates them emotionally, which can lead to feelings of helplessness, hopelessness, anger, and depression in the absence of adequate emotional support.

Another typical effect is a sense of loss and rejection on the part of siblings. Most are too young to understand the logic and exigency of the situation, which can breed similar feelings of helplessness, hopelessness, anger, and depression in children.

Conflict takes on a wide variety of forms, but here are some pretty common ones:

Tattling

Comment on this if it is a pervasive problem. If it is a referral concern targeted for intervention, you can refer to the part of your report where you analyze it in more detail. If that is the case, then simply mention that it is a pervasive problem, or whether or not tattling predominates sibling relationship (as in the “Indifferent” category above). Your comments can include descriptions of form and speculations of function – but you need not repeat information you will cover in another section.

Acting Out

Frustration and anger are feelings that motivate acting out behavior. Describe the forms of behavior that seem to be related to such feelings. Also, describe what the factors are that frustrate the siblings most. In the case of frustration or anger, what is typically observed is behavior resultant from the accumulation of stress and implicit feelings that have long been percolating underground. These feelings are punctuated by more acute feelings and boiling points that result from individual episodes in the present.

Social Interaction with Peers

If social interaction with peers is a primary referral concern, then it is only necessary to introduce the topic by describing some forms of the behavior (e.g. withdrawal from peers; indifference; hostility or aggression, etc.), and then refer to your more detailed description below.

If relevant, use this section to describe differences between the Student’s interactions at home with caregivers and siblings, or even familiar friends, and how she does in the much more fluid and dynamic settings of peer groups, playgrounds, and large family gatherings. It is very typical to see a pattern in children with PDDs a pattern of relative comfort, affection, and two-way interaction with the Student’s small circle of familiar partners, rather than people outside the home. This is of course due to the exponentially increased requirement for emotional referencing and signaling in fluid, multiple peer settings, or with less familiar peers.

Communication Level, Style

Describe here the means in which the IP communicates. Describe the means in which the IP understands communication (receptive communication) as well as how she uses communication to express herself to others (expressive communication). It is important to assess communication levels to determine if they are adequate to meet the needs of tasks and environmental situations (most importantly, social interaction). If they are not, communication skills and deficits are remarkable.  If the IP’s deficits in communication have a likely functional relationship to the behaviors under assessment, they should be mentioned here as, well as in the Antecedent Setting Conditions section.

The Differences between Communication, Language, and Speech

Communication

Communication is the totality of means/strategies that one uses to understand and convey meaning. It can include speech and language, but it also includes non-verbal forms that are always present. With the exception of written communication, language and speech are almost always accompanied by emotional and other forms of gestural communication.

Behavior is communication: It is axiomatic in the field of Functional Analysis of Behavior that behavior is communication. In this regard, communication is either intentional or unintentional.

Language

A language represents agreement among a community of speakers that certain sounds, words, and combinations of sounds, words, and sometimes gestures have common meaning. For instance, in the community of English language speakers, the sound string “b-o-y” means a young male. Spanish or Japanese speakers are not in the community of people that agree that “boy” is the symbol for a young male – they have their own words for a young male.

The symbols of one language are different that other languages. Language has the following characteristics:

• A language is a system of communication. The system has rules that govern its use.
• Languages use symbols to convey meaning. Symbols can be spoken words, manual signs, gestures, and in most modern languages: written and/or pictorial forms.
• Language is specific. Language is judged by the precision in which it is used.Spoken or written words can be nonsense. Spouting off words or symbols is not necessarily language use. There has to be some intent to convey a specific meaning to a recipient.

Speech

Speech is the oral-motor aspect of communication, usually in the form of words, but is also can be in the forms of vocal-play, or babbling.

Vocal Play

Vocal play is the long strings of consonant-vowel syllables produced in self-imitation, such as ba-ba-ba-ba. Vocal play consists of nonsense sounds the Student makes. In neurotypical development, vocal play is prominent in the latter part of the first year of infancy. It is a genetically driven behavior, required in order for the brain to develop coordination of the oro-muscular [oral- or vocal-motor] apparatus.
Think of vocal-play as speech-linguistic exploration behavior.

Babbling

This refers to the repetition of phonemes, such as ba, ba, ba, da, da, etc. These are beginning to sound like speech.

Jargon

Strings of unintelligible speech sounds with the intonational pattern of adult speech.

Jargoning tends to sound like real conversation; only the real words are missing. It typically carries the prosodic[18] elements of speech, and is often accompanied by active joint-attention behaviors. When you see a Student who is truly jargoning, you get the feeling the Student knows exactly what she is saying; only she’s using a made-up language.

Five Stages of Prelinguistic Vocalizations

Crying: Reflexive vocalization that occurs automatically whenever an infant is overly aroused.

Cooing: Sounds consisting largely of vowel sounds that express pleasure and contentment.

Vocal play: Sounds which vary greatly in pitch and loudness, including occasional simple syllables.

Canonical babbling: Vocalizations consisting of strings of syllables that sound increasingly like speech.

Conversational babbling or jargon: Infants begin to use adult-like stress and intonation. Jargon sounds like conversation. Sound production begins to change to match the phonemes of the native language. By 10-12 months most children begin the transition to true speech.

Protowords: Vocalizations that seem to have consistent meanings for an IP and are used in attempts to communicate, but do not closely resemble real words.

Communication Level has to do with the types of representation the IP uses, going from non-symbolic, to pre-symbolic, to symbolic forms.

Non-Symbolic Forms

Non-symbolic forms do not make use of joint attention. Generally, there is a single function that they have – to indicate distress of some sort. Non-symbolic forms of communication have the function of (first) emotional release, and then (and not necessarily in tandem) to intentionally elicit caregiving help (a “requesting” function).

Crying

Crying can be differentiated among several different forms. In neurotypical development, crying goes from undifferentiated or amorphous forms to differentiated forms where other people can get a good idea from the sound of the cry what is wrong.

Undifferentiated/Amorphous Crying

This is typical of children functioning developmentally in Sensorimotor [Cognitive and Linguistic] Substage I or II. In children toddler-age and above – this very likely represents profound levels of mental retardation.

Differentiated/Specific

Within a few months after birth in neurotypical development, mothers (especially) can tell whether their baby is hungry, tired, bored, or otherwise distressed simply from the sound of their cries.

Even though the sound of the cry may be a good indicator of what is going on, the question of the IP’s intention can be in doubt. While the IP does not have an idea of a specific idea that is to be created in the hearer’s mind (as in joint attention/Theory of Mind) – which is the essence of symbolic communication, the non-symbolic IP can still assist the caregiver by continuing to cry or even crying more intensely if the caregiver is somehow misattuned.[19]

Performance

‘Performance’ in this respect is not intentional communication. It does however carry the message of “This is what is going on with me…”

In line with the axiom that “behavior is communication,” there is a message to others that comes from what a person does. For instance, when we see a child climbing onto the countertop and reaching for the cookie jar, we get the message that he wants a cookie.

In behavior analysis, it is often necessary and important to assess the difference between what someone says and what he does. The analysis of congruence between verbal communication and behavior can be the most important thing to know about the referral concern. Since children with autism are often taught word labels for feelings in an artificial and too-abstract manner, they will often report feelings that have nothing to do with their actual emotion. In such cases, it is crucial to analyze and remark about the performance-to-actual meaning congruence relationship.

In another common occurrence among children with ASDs, a Student will stand in front of the door when he wants to go outside, or stand in front of a cabinet when he wants something from the inside – without looking back at, or doing anything further to manage the attention of or increase the understanding of the caregiver. This too is performance communication.

Acting-Out Behavior

“Acting Out Behavior” is a term traditionally used by psychologists to describe behaviors that carry the message of the emotional state of the individual. For instance, a person might steal things they don’t need or even want from people they have relationships with. In such a case, anger is usually the emotional state, and stealing is the acting out behavior.

AOB is frequently confused with violent behavior. While AOB can indeed be violent and serve a function of emotional release for the individual, acting out does not necessarily involve violence.

Pre-symbolic Forms of Communication

Associative Forms

The use of symbols is somewhat random at first, but by trial and error the user learns that certain symbols are associated with environmental events. There is a difference between using a symbol – and conveying specific meaning.

For instance:

A 3-year-old has been taught through direct teaching and reinforcement, 10 manual signs. When asked “What do you want?” she goes through her entire list until her communication partner figures out what she wants. Over time, she learns to make more precise associations, but she doesn’t really understand what the symbols mean to the other person. She doesn’t understand that words are referents for other things – symbols. She just knows that a certain word produces a specific result.

A pet parrot does the same thing. The parrot speaks when it wants attention, but will say anything and nothing in particular. The parrot is aware of the reactions he gets from people for various things, but speech is a gimmick for the parrot, not real language. He’ll go through his entire vocabulary (including uncanny imitations of the telephone ringing, the garbage-truck backing up, people’s laughter, etc.), until he can get someone to enter the room and interact with him. However, most of the time, the parrot doesn’t speak when people are already paying attention to him. That is when he resorts to his innate and species-specific squawks and calls.

Joint Attention

Joint attention behaviors have to do with the Student’s efforts to direct other people’s attention, especially for the purpose of sharing experience (see Primary Deficit: Experience Sharing, p.15). They are very important in differentiating between Autism Spectrum disorders and language disorders and mental retardation (without autism).[20] These behaviors/skills develop before language, and they involve the coordination of two people’s attention to something else – a “joint reference.”[21]

Joint attention acts can be further divided into acts that involve the Student’s following an adult’s focus of gaze and those that involve initiating joint attention bids. There is substantial experimental evidence for impairments in both the production and comprehension of joint attention behaviors in children with autism. Children with autism tend to display fewer joint attention gestures than requesting gestures. They may be able to use gestures to request objects and engage in social action routines, but they tend not to use gestural acts to indicate or share awareness of objects or their properties

23-month-old Renee does something cool with a toy. She looks up to see if anyone else saw it too. If no one did, she makes an effort to do it again so someone will see it. She actively searches other people’s faces and eyes for signs that they’ve noticed. When they smile—she smiles back.

An important separation is made between imperative triadic exchanges, in which the Student’s behavior has an instrumental function, and declarative triadic exchanges, in which the Student’s behavior serves to share awareness, or the experience, of an object or event.

Be sure to remark about a lack of joint attention behaviors if you feel it is related to the behavior. If you’re performing a Developmental Assessment, then you must describe the forms joint attention take if they are present, or the way a Student communicates without them if the majority of their communications are instrumental.

Joint attention can be observed in the following behaviors, each of which is remarkable:

Gaze-shifting

The IP’s eyes shift back and forth from the reference object to the communication partner’s face and eyes.

Gaze-monitoring

The IP observes the communication partner’s face and eyes to make sure the partner

Emotional referencing

The IP attends to the emotional gestures (i.e. facial expressions, body-language) of others in order to regulate their own communication or co-regulate communication along with their partner.

Theoretical Types of Joint-Attention

Non-visual Joint Attention Behaviors

Joint attention can be coordinated over the telephone, or the referent can be something outside of the “here-and-now.”

Joint attention can come into play when statements are preferenced with e.g., “You know when…?” “Have you noticed that…?” In order for communication to include joint attention, the speaker needs to pay attention to the response, taking into account the attention and “mind” of the partner.

Here’s an example of a case where joint attention is not observed:

Two 5-year-olds:

P¹: “I got a new bike at home.”
P²: “My mom’s coming to get me soon.”

P1: “It’s red and it has chrome handlebars.”

Here’s a conversation that includes a non-visual form joint attention:

Telephone conversation:

P¹: “You know how Monica likes to climb on things…?
P²: “Oh yeah – she’s always climbing on things…”

Symbolic Forms of Communication

Symbolic forms of communication range from concrete to abstract.

• A ‘concretion’ is tangible. It can be experienced through the physical senses (it can be seen directly, touched, smelled, heard, etc.). Concretions are easily agreed upon by the communication partners(e.g., two observers would readily agree that what they see before them is a “dog,” whereas they might disagree about whether the dog is a “small” one or a “big” one).
• An abstraction is intangible (e.g., “fair,” “big,” “snack” [Is an entire pizza a snack for one person? – two persons might disagree on that]). An abstraction is a value that is culturally and personally defined.

Table of Levels of Symbolic Communication

Most Concrete

Non-Symbolic Means

Differentiated Crying Only when intentional – uses crying to communicate a message – with knowledge of the typical reactions/consequences specific cries have.

Pre-symbolic Means

Gestures: Includes pointing, making specific sounds, emotional/affective expressions, etc.

Object Communication: Uses the presentation of objects to convey simple messages – usually requests: (e.g. brings bottle to Teacher to obtain more milk); recognizes the meaning of actions and objects (e.g., when Dad takes his keys off the hook – it means he’s leaving).

(Representations)

Simple/Direct: These include parts of objects (e.g., a bottle represents a bottle of milk; a doll represents a real person; a toy truck represents a real truck, etc.).

Picture Symbols: A picture or drawing represents reality. Photographs of objects are the most concrete, and inexact line drawings would be less concrete.

Complex/Abstract: These include objects that can only be understood with some imagination (e.g. Student cups his hand and pretends to drink; uses a broom to represent riding a horse).

Words, Manual Signs: These are not as universal as imaginative representations (above), because they must be agreed upon by a community of speakers (see Language, p.35). Words and manual signs often make reference to objects, actions, or ideas that are separated by time and place.[22]

Concrete References: These include words or signs that refer to tangible objects and observable actions. There is a high likelihood of inter-observer agreement with these referents.

Abstract References: These include words or signs that refer to intangible concepts (i.e. categories based on rule-based inclusion/exclusion criteria such as a fruit must grow from a plant and contain seeds, etc.), ideas, opinions, and other subjectively defined references.

Rebus: These include picture symbols strung together sequentially to represent a sequence of ideas, a sentence, or a story. Think of the old game show “Concentration.”

 Written Means

Simple Decoding: Simple decoding is the first thing learned in reading. It starts with mapping sounds to symbols (e.g., the sound ‘k’ can be ‘mapped’ to the letters k, c, cc, ch).  Reading decoding progresses to the deciphering of words as strings of sounds (not necessarily deciphering meaning).

Comprehension: This includes reading for meaning. The person can go beyond deciphering words to real understanding of written material.

Most Abstract

More About Concretions vs. Abstractions

Think of concrete v. abstract as a continuum rather than separate categories. A symbol can at different times be concrete (e.g. jump meaning leaping up [physically], “Go ‘jump’ on the trampoline…” or it can be abstract, “That assumption is quite a ‘jump’ from your last one.”

A concrete level word usually describes something you can experience through the senses (i.e. you can see it, hear it, smell it, taste it, touch it, etc…).

Concretions

These are singular and tangible items such as a cup, TV, Mommy, banana.

Lower Level Abstractions/Concepts

Abstract words go from simple to complex. The simpler abstractions include words that describe “classes” of things with common attributes, such as “red,” “vegetable,” etc. (things you can still see or touch, etc., but that include more than 1 particular item). They include things that have common attributes such as color, shape, function, class, etc, i.e. red things, big things, square [shaped things]; animals, etc.

A banana is a concretion whereas fruit is a concept.

A penny is a concretion whereas money is a concept.

Level II Abstractions

At a lightly more abstract level, you have words that require the knowledge of two concepts at once, such as relative terms like “big” (“big” is only big when you compare the big thing to something else), ordinal terms (“second” is only second when it’s between first and third), etc. Other comparative and “ connective” terms might include good/bad, directions such as up/down; prepositions (“on top” – on top of what?), etc.

Level II abstractions can also include feelings, as long as they are among the basic emotions of happy, sad, angry, afraid, etc.

A bed is a concretion, bedtime is a concept, and sleepy is a LLA.

A bowl of cereal is a concretion, breakfast is a concept, and delicious is a LLA.

Level III Abstractions

At a lightly more abstract level than above, you have words that require the understanding of changing relationships and context. Pronouns are at this level, because in a conversation, words like, “his/her,” “he/she,” I/me/you,” etc., require you to switch back and forth according to changing relationships. In other words, when you give me something that is “yours,” it is now “mine.”  When I refer to “you,” you are supposed to understand that it is yourself or “me.”  Typically developing children still have trouble with this into their 3rd and 4th years.

Level III abstractions can also include slightly more complex feelings, such as frustrated, disappointed, silly, etc. They do not include [highly] blended emotions such as guilt, embarrassed, joy, etc.

Functions of Communication

Include all functions associated with Sensorimotor Substage III and above, but comment on the presence or absence in the IP’s behavior for each one. Remember, absence of a skill is referred to as “does not yet” rather than cannot or does not…

Functions of communication are purposes in which communication is used.[23] They can be non-linguistic/performance, pre-linguistic/pre-symbolic, or they can be linguistic/symbolic (be sure to note which). Children who are acquiring language often use combinations of non-symbolic/performance, pre-symbolic and symbolic forms to satisfy language functions.

Typical functions of communication (non-exhaustive list)

Regulatory Functions: for basic regulation of self or other’s actions.  The IP is just trying to get a need met. It does not matter who meets it.  The relating is instrumental – not for the purpose of sharing experience or social interaction.

Protesting, Refusing
Says, “No;” shakes head, “No;” turns head away; pushes object away; throws object; cries, whines, or tantrums, etc.CessationAsks to stop; “All done,” “No more” “Don’t want…,” etc.

Requesting Objects
Brings diaper to request change (object presentation); points to object; says, “Please,” “Mine,” or “Me,” etc; asks for object by name using a single word (“juice”); asks for object with a sentence or statement “[I] want juice” etc.

Requesting Services
Asks for “help;” says, “Go;” refers to actions needed, e.g., “Open please” “Go to park,” etc.

Greetings (Instrumental)
Uses conventional greetings and salutations as taught by social instruction.Co-regulatoryRefers to matters of degree, e.g., “faster/slower” “bigger” or subjective references such as “too much” “that’s good,” etc.

Temporal
Indicates when by referring to sequence (“after dinner”), duration (“in a minute”), or temporal placement (“…on Friday” “Tonight/Tomorrow/ Today…”); ordinal: first, next, second, last, etc.; uses abstract references such as “soon” or “later,” etc.

Requesting Information
Asks questions; uses or repeats a label e.g., “Daddy, Daddy” to ask where Daddy is), etc.

Giving Information
Answers questions; uses more than single words or rote phrases to convey information and meaning – gives details and directs [joint] attention through words and gestures; instructs, gives directions, etc.

Social  or Co-regulatory Functions: for regulation of social interaction – EXPERIENCE SHARING/SOCIAL DISCOURSE functions

Describing, Labeling
Uses words or gestures, e.g., “ball” “Mommy go.” “That’s a fish.” “I bought a fishing rod the other day for $50.” etc, usually accompanied by a joint attention gesture such as pointing; indicating “finished;” naming objects depicted in pictures and books; using people’s, pet’s, or character’s  names, etc., telling stories, describing episodes of experience

Requesting Interaction, Social Engagement
Initiates social interaction with some sort of communicative bid (i.e., words, gestures)

Maintaining Interaction
Makes gestures or uses words that share one’s experience; responds to other’s similar communication bids. Communication is reciprocal and involves mutual turn-taking of expressing and listening

Co-regulating
Uses gestures or words for communicative repair in case of communication breakdown: clarification; emphasizing; re-wording; repeating; focusing and re-focusing partner’s attention…  (Co-regulatory language is often instrumental: when partner’s are engaged in a mutual task, e.g., “Go a  little faster” “Wait a minute” “Not that one – that one.”)

Terminating
Uses words or gestures to close or end an interaction or make a transition

Time Travel
Uses word “tense” to indicate past, present or future context of the words; relates events from past or to anticipate future events

Speech-Motor Disorders

As mentioned, speech is an oral motor form of communication – essentially a motor act, but a very specialized and extremely complicated form of motor movement. Complex human speech is without question, the most complicated motor act in the animal kingdom. Speech occurs “downstream” from other parts of the brain that are responsible for the thoughts and intentions of oral communication, but it is not the end of the line. People hear their own speech and use that feedback to monitor the volume and quality of their speech production.

Apraxia

Apraxia is a motor disorder in which the ability to select and sequence movements is impaired. Apraxia is often associated with oral-motor movement (i.e. speech; as well as swallowing, oral gesticulation, etc.). Apraxia can be present from birth (as it usually is with children with pervasive developmental disorders), or it can be acquired as a result of brain injury, seizure, or stroke.

In terms of behavior assessment, relative ability to formulate ideas and a normal desire for communication can result in both acute and chronic levels of frustration. These children are commonly misunderstood when they try to speak, or they are corrected when they really just want to get their message across. The constant bottleneck of ideas to speech

Oral apraxia

This affects the ability to move the muscles of the mouth for non-speech purposes. Someone with oral apraxia would have trouble coughing, swallowing, wiggling the tongue, blowing, etc.

Verbal apraxia

This refers to apraxia of speech, which represents impairment in the sequencing of speech sounds. Errors in apraxic speech are unpredictable. Apraxic speakers “grope” for the correct word; they may make several attempts at a word before they get it right.

Developmental Apraxia

Developmental apraxia of speech (DAS) is a disorder that occurs in children and is present from birth. Apraxic children do not develop speech normally and are unable to produce consonant sounds. Some children with DAS have generalized problems with coordination.

Dysarthria

Dysarthria is a speech disorder that is due to a weakness or dyscoordination of the speech muscles. Speech is slow, weak, imprecise or uncoordinated.

Dysarthria involves muscle weakness whereas apraxia does not. Therefore, the errors heard in dysarthric speech are usually consistent and predictable, while they are not with apraxia.

The act of speech involves the delicate coordination of a number of perceptual and motor subsystems. Dyscoordination or weakness in any one of the systems can result in Dysarthria.[25]

What are “Means?”

“Means” are simply the tools and ways available to realize an intention. “Attachment means” are the strategies the IP uses to enlist caregiving and emotion sharing, as well as the attachment figure’s ability to respond in an attuned manner. They have to do with how the IP integrates and brings his or her emotional, cognitive, linguistic, and motor skills to bear when he has a need to reconnect with attachment figures, and they have to do with the flexibility and mind set of the attachment figure’s response.  So to be clear, these sections describe the skills and deficits that the IP currently has, and how that predisposes referral behaviors.

There is a lot to read and a lot for you to learn in this section, but we are looking only for remarkable information.  Here again, we are not looking for answers to all of the questions we ask here – just those most relevant to the referral concerns.

Areas to assess:

Emotional Attachment Means

This section has to do with the skills the IP has to maintain a sense of emotional well-being and availability for learning and emotion-sharing experiences. The IP that gets upset easily, has difficulty calming himself or herself or is not easily calmed by others, then they are more subject to negative reinforcement in the environment. Further, they have the effect of delaying their development because they tend to remain in static systems and withdraw from normal levels of uncertainty and novelty. The IP with an optimistic, “approach stance” towards novelty and uncertainty is more available and likely to be more flexible.

But we have already assessed neuroregulation in the above sections – so this section is not merely about the IP’s internal mechanisms. Attachment is about how people regulate their emotions in the context of interdependent relationships. It is about signaling and responsiveness to others in the IP’s efforts to maintain well-being. This section looks at how the IP conveys emotionality to others and uses and responds to relationships to maintain emotional availability and to embrace uncertainty. It looks at how available the IP is for interdependent, co-regulation of emotions.

But importantly, it looks at the environment as well. It looks at how well others are able to read the IP’s emotional needs and respond effectively.  Are they attuned? Do they make efforts to attune or do they simply view expressions of emotions as inappropriate behaviors?

To complete this section, it is useful to look at both ends of the attachment relationship: the IP and attachment figures in the IP’s life.

Development of Self-Regulation and Autonomy

As children mature emotionally, they move from highly dependent and proximal forms of self-regulation, to more symbolic and interdependent forms of self-regulation:

Dependent/Non-symbolic Means

The Student depends greatly on others to self-regulate and shows little ability to self-regulate in productive ways.

• The IP requires the physical presence of caregivers in order to restore regulation/proximal, dependent style
• The IP  often resorts to repetitive, infantile, or self-stimulatory behavior in order to restore regulation/ withdrawn, sensorimotor, or non-symbolic      style

Interdependent/Symbolic Means

The IP relies on others to self-regulate in a mutually interdependent way.

• The IP seeks help and comfort from others using words, gestures, or symbols.
• The IP is able to remain calm and focused enough for problem solving or solution      finding.

Relationship to Coping Skills and Play

An IP’s ability to cope with negative feelings or adverse circumstances is related to how his self-regulatory system works.

Hypersensitive or high-strung children tend to become easily dysregulated (act out, melt down, explode) when faced with negative feelings or adverse circumstances (i.e. having to wait or defer gratification; coping with frustration or disappointment; coping with demands).  These children can be bossy, bullying, aggressive, rigid, defensive, or controlling around peers.

Hyposensitive children have more of a tendency to withdraw or act helpless when faced with negative feelings or adverse circumstances.  These children can be unmotivated, helpless, or avoidant around peers.

• When the IP dislikes or otherwise has a negative reaction to something, how does she go about solving her problem?
• Can the IP step back from a problem that is causing too much frustration – or is he or she seemingly stuck repeating frustrated efforts until he or she melts down?

Another main consideration is whether the IP works with others and can remain open to receive help – or does she resort to coercive tactics?

• What does he do when he’s relatively calm?
  • Does he attempt to express himself, or does he act out his frustration or anger?
• When getting upset, does she remain stationary and cry helplessly – expecting others to move in, or does she remain organized enough to approach caregivers?
  • Can she engage in two-way communication when a problem occurs?
• At what point, or concerning what issues does he lose his ability to engage in mutual problem solving?

The IP’s Attachment Means

Assuming that the IP is the recipient of caregiving rather than a Caregiver, we assess the following variables:

• Does the IP send clear, readable affective signals?This is not about verbal communication, which is assessed in a subsection below. This is about sending readable signals to others that help them attune to the IP (sounds and actions expressing emotions that are clear to      Caregivers).  Some infants take a long time or never really develop different cries for different things.  Some individuals, especially those that started life with Sensory Integration Dysfunction, can show confusing affects (e.g., they may be smiling but angry and aggressive at the same time), or they may be relatively affectively flat – showing little expression at all.  Some, especially those that experienced abuse or trauma at the hands of Caregivers send confusing or incoherent signals that reflect very high levels of anxiety.
  • Does the IP show unreasonable or exaggerated signals that seem out of proportion to the distress involved?
  • Does the IP get over-excited or overstimulated to the point of becoming disorganized in their behavior?
  • Does the IP respond easily or with difficulty to Caregiver efforts to stimulate and/or soothe (engage in co-regulation)
• Does the individual have a static, withdrawal stance towards novelty and uncertainty, or does the IP embrace novelty and at least mild uncertainty?
  • Is the IP generally rigid and inflexible or open and adaptable?
  • Does the IP generally respond by studying reality for a moment and responding or does the IP react reflexively
  • Does the IP impose templates of past relationships on current ones or does he or she treat different people differently?
    • Are the patterns of relating seen similar across all people?  If not, describe how the IP relates differently to some people or people in roles (Caregivers, Teachers, peers).

Caregiving Patterns in the Environment

• How well do Caregivers attune to the IP’s needs?
  • Is the problem more of difficult to read signals from the IP, or the Caregiver’s misattunement?
  • How does misattunement predispose the referral behaviors?
  • Are Caregiver patterns individualized to the IP, or are they inflexible?

Social Attachment Means

This section deals with how the IP uses or benefits from social relationships to handle emotions related to the referral behaviors.

Caregivers and Intimate Relationships

We tend to rely interdependently on our loved ones to help us through difficult times.  We also want to share our positive experiences with them as well.  So here we look at experience-sharing in general, both positive and negative, and how these patterns of relating predispose referral behaviors.  We also look at axes that involve overly independent (avoidant) versus interdependent forms of attachment bonds(healthy, as well as possible clingy and overly dependent).

Self v. Other

This is an axis that goes from overly independent (possibly avoidant) to the health of the IP’s interdependent relationships.

• How does the IP use or benefit from interdependency, experience-sharing and co-regulation of emotions?
  • Does the IP approach others to share experiences, positive or negative, or does the IP tend to avoid others or not realize that others can be helpful?
    • How does the IP approach others and for what reasons?
    • Does the IP approach others to share affective/subjective experiences at all, or does he or she only relate to others when they want or need something (instrumental reasons)?
    • Does the IP expect others to be helpful, or do they tend to handle things themselves?  In general, if the IP tends to handle things alone, it is at a cost or he or she does it in maladaptive ways (e.g., keeping everything bottled up; engaging in destructive or self-injurious ways; exploding till spent)
    • If the IP has difficulty or does not do this, is it because he or she cannot due to difficulties knowing how they feel?
    • If the IP has difficulty or does not do this, is it because he or she has generalized difficulties with communication, or just difficulty communicating or trusting others to communicate how they feel?

Attachment v. Exploration

• Is the IP generally secure and able to engage in a healthy balance between attachment and exploration behavior?  A secure person wants regular contact with loved ones, but is not clingy, dependent or controlling of others.  A secure person enjoys learning and exploring the world.  They are not worried so much about the security of their relationships that they spend undue energy on controlling Caregivers or other intimate relationships (friendship; lovers).
  • Is the IP preoccupied with controlling the whereabouts and availability of Caregivers?
  • Does the IP avoid relationships, relating only when necessary and for instrumental purposes mainly?
  • Are the IP’s relationships exclusively with Caregivers for purposes of receiving caregiving?
  • How much is the IP able to get his or her emotional needs from Surrogate attachment figures such as Teachers, friends, peers?
  • Does pride in accomplishment motivate the IP (attachment to self)?
• Subjectivity and Intersubjectivity
  • If the IP has difficulty  or does not do this, is it because he or she lacks capacity for  understanding his or her own perspective (little or no knowledge of self – as in developmentally young children that are expected to be the subject of their feelings rather than to be able to look at them in terms of cause and effect – see Cognitive means below)?
  • Does the IP tend to be self-reflective and to see his or her role in problematic relating?
  • Can the IP take the perspective of others, or do they rely mainly or only on self-reference points?

John Bowlby described the idea of an “internal working model” that individuals use to develop expectations for new relationships.  This is a very important part of the antecedent setting conditions for any social function of behavior.

• Does the IP have fixed and rigid expectations of others?
  • Does he or she expect them to adapt to him or her all the time?  Do other in the home or school environment negatively reinforce demanding behavior?
  • Does the individual trust  others?  Do they expect misattunement?  Do they expect abusiveness or abandonment and begin relationships by testing Caregiver  commitment to them?
  • Does the individual engage in frequent testing of what works to get attention, without referencing the appropriate ways use to get it and the amounts of attention others expect to get?

Cognitive Attachment Means

Cognitive attachment means have mainly to do with concepts of time, sequence, and waiting. Concepts of place and distance are related to the time it takes for caregivers to respond.  Concepts of time and duration and sequence rely on the ability to recognize patterns in the environment that help the IP understand how long he or she will have to wait for things like attention, reunion with loved ones, etc.

Initial concepts of sequence and duration are formed very early on, as the infant watches the patterns of Caregivers and develops ideas of how long things take, the steps involved, business v. availability of attention (see “The Goal/Corrected Partnership below).

The Two Infants and the Bottle

In this example we look at how two 5 month old infants handle the potential distress of waiting to be fed.  One of them is developing typically, and the other – possibly heading towards autism and who does not pay attention to patterns of other’s behaviors (tracking, monitoring), is developing atypically.  Both infants get hungry at the same time and start to cry or signal hunger?

The attuned mother hears the cries and responds, “OK, honey, I’m getting you the baba.” But she does not approach the baby.  She goes to the refrigerator, retrieves the bottle, washes off the nipple, and pops it in the microwave for a few seconds.  She announces, “OK, it’s ready,” and then she approaches the baby, seats her in her lap, and then begins giving her the bottle. The baby is now satisfied.

Now, if we look at the above sequence of actions that starts with the infant signaling hunger and finally getting fed, we can see it as analogous to a “behavioral melody,” just as individual notes are connected into a single idea or “behavioral gestalt” where each individual action is meaningful only in terms of its part in the sequence.  The question is, “how many notes does it take for the infant to ‘name that tune?’”

The typically developing infant can recognize that tune in just a few notes.  She would only complain if the sequence were unusual (e.g., Mother answers the phone in the midst of the sequence and she does not continue to follow through typically, or, the steps are taking longer than the infant has come to expect).  She might stop crying as soon as Mother says, “OK, honey, I’m getting you the baba.”  Maybe not.  She might not stop signaling until she sees Mother actually taking care of business – going to the refrigerator, etc.  Generally, as soon as Mother initiates the sequence, the baby’s anxiety lowers and so does the intensity or urgency of the signaling.

Patterns like this can be ambiguous.  We are always looking for reference points that let us know the availability of social attention (attachment-related behavior) or other things we might want.  For instance, it can be very difficult for children (and others) to be able to tell how long someone will be occupied by the telephone, work, shopping, etc.

The Two-year-old and Mommy on the Phone

Typical two-year-olds are both very concerned about Mom’s [Caregiver’s] availability and unable to judge how long certain things take.  They can be very familiar and comfortable with behavioral melodies/gestalts that consist of tangible actions and procedures.  But they’ll have difficulty being able to judge how long more complex things such as talking on the phone, seeing Mommy on the computer or talking to another adult, etc. will take.  Their primary concern is Mother’s availability.  They’ve only recently emerged from attention on demand sequences that were typical of the first half of the first year, and are struggling with deferring their needs or appraising the real availability of the Caregiver.

Because the two-year-old has this difficulty appraising Caregiver availability, he predictably begins to act up as soon as he sees Mom get on the phone.  He may not be able to tell if she’ll be a long time (as when she’s talking to relatives or friends), or a short time (ordering a pizza).  But what he has perfected is his strategies for getting her off of the phone!

Even as adults, we can have difficulty if we do not really understand the sequence of things, such as how long it might take to get the results of a test.   Stanley Greenspan maintains that things like duration are too long when they take longer than expected and they are too short when they are shorter than expected.  He points up the relationship between our behaviors and our expectations.  We get impatient and maybe irritable, because we don’t know how long a response will take.

I’m saying here, that we tend to use conceptual guideposts such as sequences, timepieces, calendars, etc. to make these judgments.  These are essentially cognitive tools.  In this section, we examine the IP’s mastery of the tools and reference points that help them know when attachment (attention) and caregiving will take place, and, whether or not or how they develop strategies for expecting or waiting.

The Clingy, but otherwise Emotionally Secure 2 ½ -year-old

Sebastian was referred for clingy behaviors with his mother. He cried whenever she was out of sight – even if she went upstairs just for a minute. He melted down whenever she left the house to go to work. When she was home, he wouldn’t play independently and she couldn’t get anything done when he was there.

He never did this with his father, and neither parent could figure out why. Their parenting styles weren’t all that different.

As it turned out, Sebastian’s father was an engineer and his mother was a nurse. Sebastian’s father had fairly regular hours. He sometimes returned home late, but he was there every night and every morning. Sebastian’s mother on the other hand had her schedule handed to her every week, and every week it was different. She always worked either the morning shift or the graveyard shift, meaning she was there to put Sebastian to bed every night.

The problem was that Mom was not there every morning. [15]  Mom would return from work sometimes after Sebastian’s father had brought him to school.

Also, as you will learn in the section on sleep (see Writing Treatment Plans); it is typical for most people to wake up for very brief moments periodically through the night. They’re called “microwakings.” Usually, we satisfy ourselves that everything is as it was when we went to bed and we go back to sleep with no memory of these events. However, when a IP notices that something is different, he can become very aroused very quickly and become wide awake with anxiety. This happened to Sebastian whenever his mother put him to bed. He would wake up in a normal microwaking and become very alarmed when she wasn’t there.

What the referral behaviors represented was Sebastian’s desperate attempts to control the availability of his mother. Since he did not understand her schedule (he was 2 ½ years old and he did not yet understand concepts of today or tomorrow, nor did he truly understand what the days of the week meant), he could ever rest in the comfort of knowing that he will see his mother for sure at a later time. The only strategy he could understand was to do whatever he could to not let her go. Even though the strategy never worked, his behavior devolved out of desperation and being emotionally overwhelmed, into clinginess.

Sophia and Frank

Sophia and Frank have been married for 17 years. Frank, a salesman, travels on a regular basis for his job. His out of town trips usually last about 2 or 3 days, and he always calls when he arrives at his hotel, and then just as he leaves his hotel for the trip home. Frank also always leaves the name and number of his hotel and flights with Sophia before he leaves for each trip.

Frank kisses Sophia goodbye. They both know that he’ll be in L.A. for 3 days. He’ll return home on Thursday, and his flight arrives at 6 pm.

Sophia did not get a call Tuesday night. This didn’t alarm her too much, but it wasn’t typical of Frank. Frank mentioned that he had scheduled a lot of meetings in a short period of time, so she figured that he was just too busy to call. She called his voicemail to tell him she loved him.

Sophia didn’t get a call Wednesday night either. This gave her a pit in the bottom of her stomach, but this has happened before she told herself, and Frank is a very reliable guy. She called his voicemail again, but this time she mentioned that she was getting worried and wanted a call as soon as possible.

Around 3:30 on Thursday, the time Frank was supposed to board the plane home; Sophia’s anxiety has jumped to a new level. She pages Frank, and he doesn’t answer the page. Her anxiety escalates further, and she resolves to let him have it when he arrives.

At 6:30 on Thursday night Sophia is now quite worried.  She calls the hotel room, the desk; she looks up his flight on the internet, and calls Frank’s secretary at her home. He hasn’t notified anyone of anything.

At 8 pm on Thursday. Sophia is freaking out. She pages him repeatedly, and emails everyone in his department. She calls the police department in L.A. and the local hospitals.

At 8:30, Frank finally calls. He forgot his cell phone charger, and due to complications with a product he had sold – he had to fix it alone, was frazzled himself, and was in a place where he couldn’t really call. Since he screwed up the sale – he didn’t want to call the office either. He arrived at his hotel so late every night that he hesitated to call home due to the time difference. He thought he was being considerate. The problems with the product would require his presence for another two days – but he forgot to notify the hotel desk.

When she heard Frank’s voice, she experienced feelings of hurt and anger, along with great relief. She let him have it, but she tempered her anger because once he explained she understood, and she was grateful that he was alright. Sophia warned him never to it again, and after hearing about how his failure to connect with her affected her – he never made the same mistake again.

The above example describes attachment in terms of plans and expectations for reunion. The plans involved sophisticated temporal (3 days; 6 pm on Thursday; flight leaves at 3:30 pm on the 18^th…), and spatial concepts (L.A. – 600 miles away and in a different time zone). Note that physical reunion was not necessary to bring about a significant reduction of attachment stress in Sophia – although she won’t be completely happy and relieved until she can see and touch him.

The example also demonstrates attachment behavior and the sophisticated range of Sophia’s attachment means. She used her cognitive concepts to form her expectations of when Frank was to call and arrive. Her episodic memory also played a great part in her expectations. She knew to call the hotel, look up his flight, and call his secretary – all concepts of their lives. She used language to acquire information and communicate – both written and verbal. All of her responses were comprised of motor actions – from speaking, to dialing the phone, operating the computer, and thinking about the past and future (see Motor Planning, below). Sophia brought all of these to bear in order to bring about reunification.

Now, an example more common to our professional experience:

Lori and Separation Anxiety

3-year-old Lori is entering preschool. Before that, she was cared for by her grandparents while Mom and Dad worked. They always picked her up in the afternoon. Lori’s Grandmother has been a regular part of her life since she was born.

Lori was born with a difficult to soothe temperament and has a mild form of autism. She does not yet understand the concepts of before and after, “this afternoon” or later. She has not yet had the experience of being in the care of other surrogate figures who would meet her needs until she reunited with her Teacher. She lacked many of the linguistic skills to express herself in a way that was readily understandable to strangers.

Lori’s first few months of preschool were fraught with problems. She cried constantly for weeks. She demanded much more attention and soothing from adults at school, and engaged in deliberate misbehavior in order to ensure immediate proximity of school caregivers.  Even when she appeared calm – she did not engage in exploring the classroom environment – something she did when she was at home – albeit in an impaired way. While she never said anything like, “I want my Mommy” or “Where’s Mommy,” the staff knew what the problem was.

Adults at school would try to reassure her that Mommy was coming “later,” “after snack” and “after the Goodbye Song.” This only made her more upset, because she only understood the “Mommy’s coming…” part and immediately looked to the door. Even when given immediately responsive attention – she couldn’t really be satisfied, and she engaged in escalated self-soothing/[primitive] self-regulatory behaviors such as rocking, hand-flapping, and even banging her head on the floor – which she did rarely at home.

Finally, Lori discovered, by repeated and rote experience, that Mommy always came after she finished her lunch. She went through a period of trying to get to her lunchbox as soon as she arrived, presumably as a sign of her magical thinking that eating her lunch would produce her Mommy. But this was thwarted by staff, and she soon understood, perhaps not on a very deep level, that no harm would come to her, and that Mommy did indeed arrive after the Goodbye Song.

Two years later, Lori entered public Kindergarten. She had still not yet developed concepts of sequencing and she still had major deficits in episodic memory. It was her peers’ individual episodic memories of previous separations and reunifications that helped them adjust to the new longer day and different routine. Lori was hardly more prepared for her entry to Kindergarten than she was for preschool. Everyone prepared for the worse – including Karen, the school’s Autism specialist.

Karen advised Lori’s grandparents to take her to the school campus during the summer session to let her meet her teachers, see her classroom, and play on the playground. Karen also had long ago made a videotape, shot from a Student’s-eye level of the Teacher doing things like Morning Circle, Story-time, Music, etc. Lori watched a copy of the tape for several weeks before school, along with her grandmother – who sang the songs and sat next to her like a peer. Karen also took pictures representing the various routines in her schedule, and made up a picture schedule for her that was placed on her desk. The day before school started, Karen conducted an abbreviated run-through of the routines with Lori and her grandmother – taking her through each transition and to each location of the various routines, in the order in which they were to take place. Lori’s entry into Kindergarten went much smoother than anyone anticipated.

Karen took great pains to enhance Lori’s ability to develop expectations of Caregiving and attachment reunion. This was wise given that Lori still had not developed sufficient temporal and spatial concepts to go through an unfamiliar form of separation without major problems. And knowing that Lori’s attachment means still consisted of primitive self-soothing behaviors, this minimized the likelihood of a constellation of defensive, attachment behaviors and trauma.

• How does the IP make use of ordinal, sequential concepts and memory to regulate attachment distress?As the IP develops memory and the ability to develop narrative sequences, he or she can tolerate more space not only in terms of time and duration between emotional refueling (short moments when attachment partners reconnect that serve as  reconfirmation of the Caregiver’s presence, emotional availability and protection and attachment security; Mahler, S. and Pine, M.M. and F., Bergman, A.; 1973; The Psychological Birth of the Human Infant, New York: Basic Books), but also in terms of physical separation.  This depends in large part on first, the development of joint attention behaviors (being able to direct other’s attention to a referent from a distance with pointing and/or words).  Being able to point at things allows the attachment pair to remain connected within each other’s eye- or earshot.  Memory allows the infant to tolerate short separations because she can remember that Mother’s disappearance is merely part of a familiar behavioral melody/gestalt, and that her reappearance is a pretty sure thing (not always a given – ask Sophia in the example above!).The development of narrative sharing, or the IP’s ability to describe events that occur in the absence of the Caregiver or that occurred in the past or that may occur in the future, allows for even greater displacements of time and place.  Finally, mastery of technology such as telephone use, writing,  email, Skype, Facebook, etc. can allow for longer and more distal separations – even from across the world.

Gregg is anxious about when he gets to go home

Gregg, an 11-year old with high-functioning autism lives in a group home. His parents pick him up on Friday every week. He begins asking his Teachers and Caregivers at the home, “When is Mommy coming?” around mid-morning on Monday, and asks the same question frequently throughout the week – at least 5 to 10 times per hour.  He did this every single day and every single week for years. He could be engaged in instrumental communicative exchanges (requesting goods and services, answering questions, and protesting) most of the time, but whenever he expressed a thought – it was the simple imperative, “When is Mommy coming?”

The supposedly experienced staff described this as a “preservative behavior” and resolved to ignore it. They pointed to the fact that Gregg could recite the days of the week, could answer questions such as “What comes after Thursday?” and even answered his own question half of the time (he would ask “When is Mommy coming?” and then if ignored or asked by adults, “When do you think?” he would readily answer, “On Friday”).

It occurred to no one that Gregg really didn’t understand what Friday meant. His ability to rotely recite the days of the week and [rotely] answer questions did not help him anticipate the moment of his parent’s arrival at all, and the answers he intermittently received from adults did little to assuage his anxiety. Instead, they were all locked into a cycle where Gregg’s anxiety lead to his questions, followed by the ineffective answers staff gave, and then his repeating the questioning as a desperate and uncreative means to manage his anxiety.

Finally, someone came up with the idea that Gregg needed a picture schedule in order to truly understand his attachment schedule (that he was prematurely forced to be in due to his life’s circumstances). This helped quite a bit, and repeated questioning about Friday was reduced by about 50%. The problem was that after years of anxiety related questioning, Gregg never really explored ways to engage caregivers by talking about other things. The simplistic approach of ignoring his questions or trying to redirect him to other topics – because his anxiety was never acknowledged – never allowed him to feel comfortable exploring other topics. At least now, the teaching of other means of engaging others can begin in earnest.

The concept of the “Goal Corrected Partnership”

This is a term coined by John Bowlby to describe a later stage of attachment where an attachment pair engages in coordinating and planning reunification (if not final – his theory has been revised in subsequent years to take into account that in some cultures, family members rarely separate for any appreciable amount of time) This is based on prerequisite temporal and spatial concepts as seen in the examples above.  Ultimately, these concepts allow for one or both partners to adjust their plans for reunion and to engage in “waiting strategies” (behaviors that help pass the time so that waiting is more tolerable).

Changes in Goal Corrected Partnerships through Development

Patterns of attachment and exploration behavior are expected to change with age and development.  They move from attachment and caregiving behavior on demand earlier in life, to co-regulated schedules based on cognitive concepts and emotional ability.  We look at differences the IP has with others his or her age, or how difficulties understanding component elements and concepts of separation predispose the IP for referral behavior.

Keep in mind that the environment expects the IP to be able to handle separation and to expect proportionate amounts of attention.  “Attention” is generally a good thing.  Attention-seeking tends to become defined as a behavior problem when (1) the way that the IP goes about it is inappropriate or coercive; (2) the IP insists on attention when it is not available, is unreasonable about waiting for it or expects immediate gratification, or; (3) the amount of attention expected by the IP is unreasonable or a mismatch for the environment.

In preschool, communication allows for planning separation based on a shared or negotiated plan that encompasses usually concepts of sequence (“Mommy will come to get you after the Goodbye Song.” Before that, infants and toddlers are widening their attachment circles to include more secondary or surrogate attachment figures (Father; Grandparents and relatives; Babysitters, etc.).  Beginning as early as 3 ½ or so, children can explore, relatively free of distress if they are engaged in interesting activities alone or with peers.  The amount of time the IP spends getting his or her needs from wider circles of attachment surrogates increases in inverse relationship to needs for refueling from primary attachment figures.  That is, the person can get their needs met increasingly from friends and becomes less reliant upon primary caregivers as sole providers of attachment gratification.   Finally, adults develop intimate attachment relationships where “significant others” serve as primary attachment figures, as well as their attachments to their own children.

Given the above, these questions are appropriate for this section:

• Appropriateness/Inappropriateness involving the way the IP goes about seeking attention
  • Is the problem the way the IP goes about seeking attention?  Describe these ways.
  • Do the ways of going about seeking attention resemble those of younger children, or are they coercive in a unique, pathological or bizarre way?
• Appropriateness/Inappropriateness of age-appropriate Goal Correction
  • Can the IP wait for a moment before the caregiver can get around to meeting his emotional needs, or does he demand immediate responding most of the time?
  • Has the IP learned simple patterns of the environment and attachment figure behavior that enable her to understand that they cannot always come immediately?
  • Does the IP understand schedules, sequences, and calendars?  Can they make use of them to understand when their attachment figures come and go?
• Proportionate/Disproportionate amounts of attention
  • Does the IP have unusual needs for attention?  Are they typical of the IP’s chronological age?  Developmental age?
  • Are their chronic and unrelieved sources of anxiety driving the needs for constant attention?
    • Are these rooted in a history of abandonment or deprivation of empathic care early that lead to chronic attachment insecurity?
    • In a related way – are  the IP’s primary attachment figures emotionally or physically available?  Has the IP had a chance to establish a secure and trusting relationship(s) with primary or surrogate attachment figures?
    • Are the anxieties related to fears of failure in academics or in peer relationships?

Communicative Attachment Means

This section refers to the IP’s abilities to use communication for the purpose of sharing emotions, getting soothing or interest from being with others, getting needs met, etc.  In this section, you also might mention whether or not the IP uses communication for relating beyond getting his or her needs met (instrumental v. experience-sharing functions of communication).  Describe the ways in which the IP communicates non-verbally and non-verbally his needs for separation and reuniting with caregivers.  Describe how the IP makes use of joint attention, prosodic, non-symbolic and symbolic, non-verbal and verbal means to regulate the availability and behaviors of caregivers?

Communicative attachment means must match the environment’s demands for separations of time and place.  A lack of ability can result in over-dependence on 1:1 attention or reliance on only a small circle of Caregivers that understand the IP’s unique ways of communicating.

We can see in typical development how the relationship between communication and narrative allow children to rely less on primary attachment figures and sustain their own emotional needs through relationships with surrogate attachment figures through the use of communication.  We have seen above that mastering distal forms of communication such as with narrative description of events, writing, and telephonic/electronic, can keep anxiety low.

Language Intentionality

• Does the individual give clear signals of their needs or intentions, or these signals so unique or self-referenced (private, idiosyncratic language; metaphoric speech; neologisms)?
• Do they take into account the understanding of others (e.g. autistic “metaphoric or private language” references such as “Barney, Barney” to indicate the desire for the goodbye ritual to begin [based upon a years-old reference to the Barney Goodbye Song in which no one in the present environment understands] vs. language based on linguistic community understanding such as “Is Mommy coming soon?”)?
• Does the IP direct his or her communication at others or is it broadcast to the world as if the IP doesn’t really understand the purpose of communication?  This is a concept called “agency,” or that people are “agents” that have intentions and that can understand other’s intentions.  The IP may be so primitive in his or her understanding of communication that they make only associations between sounds or actions they make and certain consequences happening.  They do not really understand that their actions are the reasons for responses from the environment.
• Are the signals she gives differentiated?
  • Lower ability individuals have a small repertoire of communication means.  They tend to use the same means or tools and forms of communication for a wide variety of functions or circumstances (e.g. cries when hungry; tired; needs attention).  If this is the case, assess whether or not there are differences in the forms (e.g., cries) that others can tie to specific communications (e.g., cries in a different way when hungry; tired; in pain, etc.).
  • Higher ability individuals can be the opposite.  They have a larger repertoire of communication means, so they may use many forms to communicate the same intention (e.g., indicates want or need to avoid something by behaving in different ways: outright refusals of different sorts; lying; making excuses; pretending not understand or hear; blaming, etc.)
• Are the IP’s directed at specific individuals?
  • Does the IP use different forms of communication for different people or different situations?

• Is there evidence that the Student can profit from language or symbols (such as picture or object schedules) to engage in goal-corrected partnerships?  Does he ask questions regarding the whereabouts of attachment figures and the times they’ll return (as in the example of Gregg, above)?

Motor/Spatial Axis

This has to do with the IP’s use of his or her motor skills and space to get attachment emotional needs met.  It really a question of who comes to whom?  Some individuals become so crippled by their emotional meltdowns that they cannot get up and seek help.  Others come rushing to them.  Others do this in all circumstances because that is the way they’ve become conditioned by others in the environment.  Others have real mobility and sensory/spatial orientation issues (as in blind children) that predispose them to highly dependent means of emotional coping.

• Does the IP approach others when they have difficulty coping with certain emotions?
• Do they approach others to share positive emotions?
• How many steps of looking will the IP engage in in order to get others to help them cope with strong emotions?
• How many places will the IP search for reference points on how to feel or what to do?

• What reference points do they use?
  • Are they social (i.e. the individual bases his or her feelings and anticipations; regulates anxiety by referencing how other are feeling or handling the situation)?
  • Or, like younger children, does the IP reference only Caregivers and rely on the idiosyncratic means developed between the IP and individual Caregivers.
  • Or, are they entirely self-referenced (how others feel doesn’t seem to matter or affect the individual)