Sunday, 10 December 2017

As our knowledge of neuro-science develops, it must inform our practice

Natasha Hallam and I were discussing the importance of keeping up-todate with current research and knowledge with George, aka Autism Advocate Dad at the recent SCERTS training in Sheffield, with Emily Reuben. This is true for all aspects of our work but especially true when working with children with social learning challenges. 

With advances in MRI technology, our knowledge of neuro-science is developing so we can see how our approach to working with children and young people with ASD should progress.

Children with a diagnosis of ASD have delays or difficulties in:

  • the development of communication
  • the development of social relationships
  • play and imagination
Studies of children with  social language difficulties actually show physical neurological differences in the way they process social stimuli. If a neuro-typical baby look at people's faces, an area of the brain called the limbic system “lights up” with a heady cocktail of dopamine, opioids and oxy-tocin being produced. This is addictive, so the more it happens , the more the baby craves it. The parent is rewarded by the baby's reactions so will do it more and more. The parent-baby interaction is set up and the path to social communication is well underway.
Children who are non-nuero-typical/have ASD do not have this response. The area of the brain is not lit up by human contact but other areas may show sparks  for certain objects which appeal to them. 

 We call this the social motivation models of ASD. This believes that early differences in social attention set up developmental processes that ultimately deprive the child with ASD of adequate social learning experiences. This causes an imbalance in attending to social and non-social stimuli which further disrupts social skill and social cognition development. So, if a child is not motivated to seek out the social attachments his skills will diminish due to lack of experience and practice. If they are motivated, the skills are practised and reinforced.
By 6 months of age, a typically developing child, begins to follow eye gaze and can recognise when they have lost a caregiver’s attention.  A neuro-typical infant may show distress when a caregiver’s eyes avert. The 'still face experiment' is a good example of this, where the infant seeks out his mother's eye contact and when she doesn't get it, she works really hard to try to make it happen before becoming distressed when it doesn't.

By 10 months of age, a child begins to shift gaze from a caregiver to objects of reference to predict and anticipate the actions of others.

By 12 months of age, a child will initiate shared attention on desired items or items that are of interest to the child. 

This means that a neuro-typical child:
  • is drawn toward social vs. non-social stimuli,
  • derives pleasure from this engagement,
  • notices attention shifts of others,
  • initiates bids for engagement, actions, and objects of interest
  • Practices ways of getting more social attention and indeed, they become very skilled.
Children with Autism Spectrum Disorder (ASD) show limited neural sensitivity to social stimuli and tend not to look toward people’s faces. They will  miss gaze shifts between people and objects and will have difficulty predicting actions and initiating bids for engagement.
Another difficulty is picking out speech from background noise:  when a neuro-typical child hears speech sounds, the sounds are processed as social or intentional stimuli, while children with ASD may just  hear sounds.
Plus, MRI scans have shown that children with ASD may use a different area of the brain to process  social stimuli (e.g., faces, speech sounds). This area is the same as we all use  to process images and sounds that are non-biologicalThis makes predictions of actions, intentions, and emotions less efficient and more intellectual. 
So what does that mean for therapy?

We need to respect these differences and early intervention is the key. We must work hard to make them see the point in social interaction for themselves. Hanen's More Than Words is a research lead, evidence based approach which shows how we can develop this, by thinking about how we set up and structure interaction. Later we like social thinking approach to take this further

The theory underlying the approach in the More Than Words programme proposes two key factors:

  1. Learning to communicate is a very social process and that children learn to communicate from birth within everyday interactions with their parents.
  2. Parents foster their child's communication development by responding to it promptly and building on what the child is communicating about. This applies to all children, including those with autism. However, it has been shown that children with autism also benefit from some very specific ways of responding to them.

We need to responsive, which means:

  1. Responding promptly (within a few  seconds of a child doing or saying something).
  2. Responding  positively – responding in a way that shows the child the parent is really interested in what she or he is saying.
  3. Sticking with what the child is “talking” about and interested in  this means not trying to direct his attention to something else when he is already focused on something or someone. We can use his interests as the basis for communication.
Being responsive involves Following the Child’s Lead, which takes advantage of what the child is currently interested in and attending to. We can, therefore, capitalise on the child’s current focus of attention. This is thought to increase the child’s ability to learn from the language he hears since his attention is already 'captured'. This is in contrast to us directing the child’s attention away from what he is interested in to something else, which can be challenging for the child.
It's so exciting: the more we know, the more we can understand and then the more effective we can be!

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