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Uh-Oh!

  • Posted on November 4, 2013 at 10:00 AM

On Saturday, Ben went with his behavioral therapist over to her house. He played with her children, worked on his social skills, and got a haircut. Things seemed to be going well for them until, for some unknown reason, Ben bit one of her children. We don’t know why. What we do know, however, is that while she was busy consoling her daughter, Ben threw a rather heavy bowl up into the air.

Before I get into what happened next, it seems important to explain a little bit about Ben. One of the services Ben receives through the school system is called “specially-designed physical education.” Basically, Ben lacks the skills necessary to participate in a regular PE class. It’s not just that Ben lacks the social acumen to successfully participate in their games. He lacks the physical skills that would enable him to participate. To put it more simply and more precisely, his SDPE teachers have spent years trying to teach Ben to throw and catch balls, and Ben’s ball skills are still rudimentary. Getting him to throw a ball with purpose is an accomplishment. Actually hitting an intended target—that’s a skill that has eluded him.

So, it’s safe to say that when Ben threw the bowl, he wasn’t throwing it at anything. But throw it he did. He threw the bowl up, gravity did its job, and the bowl came down. Unfortunately, the bowl came down on his young friend’s head, leaving a gash right above her eye brow. Shortly afterward, I took a call from our therapist who informed us that her husband would be bringing Ben home while she took her daughter to the emergency room for stitches.

That’s not the kind of call a parent wants to receive. It’s not that we objected to her planned course of action, of course. We had no problem with her husband bringing our son home or her decision to tend to her daughter. We supported that fully. But her daughter needed stitches because of our son!

Luckily, this therapist has known Ben for a long time now. Her husband and her children know and appreciate Ben. While, under different circumstances, such an incident could result in broken friendships and the loss of a therapist, that didn’t happen.

In fact, the very next day Ben’s therapist came for him and brought him back to her house. When Ben and his young friend saw each other the next time, they gave each other a hug. I didn’t see it, but I’m sure it was very sweet.

The whole thing does, however, reveal a concern. The biting we knew about. We try to prevent it and we try to eliminate the behavior—Ben has gotten much better!—but there’s still more work to do in that quarter. At least we knew about that!

As I said, Ben isn’t really prone to throwing things. We’re certain he didn’t mean to hit his young friend. But the object lesson here isn’t likely to have sunk in either. I doubt Ben associates his action (throwing the bowl) with the consequence (it hitting his friend in the head). He might. I don’t know. Either way, the fact of that matter is that we’ve put so much effort in teaching Ben to throw that now we have to teach him when, where, and what not to throw. Here I’d thought we’d been doing that all along!

The Relevance of Self-Efficacy

  • Posted on January 29, 2010 at 3:05 AM

Another thought spurred by my studies starts with this definition:

Self-efficacy refers to an individual’s convictions (or confidence) about his or her abilities to mobilize the motivation, cognitive resources, and course of action needed to successfully execute a specific task within a given context.

The Fundamentals of Organizational Behavior, 4th ed., by Andrew J. DuBrin, 2007, pg. 126

The chapter is on motivation, particularly as it is applied in work situations.  It relies heavily on psychology.  Two particular applications of this definition of self-efficacy stood out for me.

First, there is expectancy theory.  Basically with expectancy theory, the idea is that people will be highly motivated if they have high expectancy, high instrumentality, and high valence.  Expectancy involves the belief that more effort will improve performance.  Instrumentality involves the belief that improved performance will improve the outcome.  Valence involves the belief that the outcome is worth the effort.  If someone does not expect that their effort will improve their performance, they’re not likely to try harder.  If someone does not believe performance is instrumental in getting the results they want, they’re not likely to perform.  If someone does not value the outcome, they’re not likely to care enough to try.

(Realize that each of these high/low values are subjective, meaning they rely on individual belief not independent reality.  For example, trying harder may really lead to doing better, but if I don’t believe that it will, I’m not likely to try harder and so I won’t do better.  Therefore, belief is a very powerful, especially belief in oneself.)

One of the things that struck me as I was studying this concept was how it serves, at least in part, to explain some of the issues in relation to autism.  So often it is easier to assume someone with disabilities, especially cognitive disabilities, cannot do something.  This assumption is so easy that people often do not stop to question why they don’t do something.  It’s like the possibility that the individual does not choose to perform is never even considered.

The first time I ran smack into this concept was when I was concerned that Alex could not catch.  I understood, at least to some degree, the complexity of the catching action and its association with later skills development.  So, that Alex couldn’t catch was something that deserved attention.  Sitting with the physical therapist, I learned the distinction between can’t catch and doesn’t catch.  Specifically, if a child does not catch a ball, first you have to discern whether the child has any interest in the ball; if not, you must then find something the child does have an interest in.  Alex can rarely be induced to catch a ball, but if you throw a Veggie Tales plush toy at him he’ll probably catch it.  Unfortunately, the perspective of this therapist seems rather rare, but I’m certainly glad she shared it with me.

The next relevant way this concept of self-efficacy is used is in social learning theory.  Social learning theory is the process of learning through observing and mimicking others.  Many parents of young children with autism will recognize the significance of this, even if they’ve never heard the term.  It was drilled in me when the boys were young that children with autism have to be taught to mimic so that they can learn.  But, in looking closer at the concept through its business applications, once again the issues of expectancy theory come into play.  Expectancy (the belief that more effort will lead to improved performance), instrumentality (the belief that improved performance will lead to a better outcome), and valence (the level of desire for the outcome) are key aspects of social learning.  Some of the things that teachers and therapists are bent on teaching my children are of no interest to them.  The valence simply isn’t there.  Yet, if they watch me use the VCR or the computer, they pick those skills up quick.  And, yes, it is through social learning—observing and mimicking desired behaviors.

And now, we’re back to self-efficacy.  While the significance of instrumentality and valence cannot be ignored (yet seems to be ignored more often than not), when teaching people with autism self-efficacy has its own relevance.  Self-efficacy (belief in one’s own abilities) is a component of self-esteem (which also includes the person’s belief that he or she is worthy of happiness, also called self-respect).  Having fundamentally different neurological processes, and growing up learning in a million different ways (some subtle, some quite obvious) that your neurological processes are inferior, is going to affect any person’s self-efficacy and self-respect.  Yet, when attaining a new skill expectancy is essential, which requires self-efficacy.  If one has high self-efficacy, then one is more likely to believe that more effort will improve performance.  If one has low self-efficacy, then one is more likely to believe that more effort will not improve performance.  If one’s expectancy is low enough, then the individual will not even try to perform.

And it all comes back together.  If we insist on trying to teach people a task for which they have low instrumentality and/or low valence without first successfully raising their perceptions of instrumentality and/or valence—then claim that since they did not learn the task they must try harder or are incapable—we are eroding (and eventually destroying) that individual’s expectancy, self-efficacy, and self-esteem.  In the long-run, this erosion creates an environment of systemic disempowerment.  Essentially, we are teaching people they can’t, because we are trying to force them to learn something for which they have no interest and for which we create no sense of value.  That “can’t” attitude further pervades their lives.

The more I learn about “normal” psychology the more I believe that the worse thing psychologists ever did was divorce “abnormal” psychology from “normal” psychology.  I suspect if psychologists opened their minds to the possibility that the assumption that “abnormal = bad” is wrong, the more they would be able to see how “normal” psychology relates to their own ineffectiveness.  Perhaps then more people would get genuine help that repairs and re-builds their senses of expectancy, self-efficacy, and self-esteem, which would lead to improved performance on the behaviors they value.

Discovering SID

  • Posted on October 10, 2009 at 12:00 PM

The Occupational Therapist for the Birth to Three program balanced a little, two-and-a-half-year old Willy on a giant, red ball.  The Speech and Language Pathologist tried in vain to get the toothbrush in Willy’s mouth.  I sat back, absorbing their various strategies and tactics, trying to determine how to use what I was learning at home.

“He’s not going to open,” the speech therapist said.

“Can you really blame him,” I asked, a little bemused.  “Brushing your teeth hurts, and it’s not like he understands how important it is so that he’ll do it anyway.”

They looked at me.  I blushed, feeling like I said something wrong.  Was a parent not supposed to admit that brushing one’s teeth hurt in front of a child?

Then, the OT said the words that changed everything.  “It’s not supposed to hurt.”

Startled, I jerked a little.  “Of course it hurts.”

“Are you talking about cavities,” the speech therapist asked.

“No.  Well, yes, that hurts, too.  But I’m talking about the gums.  Brushing your teeth hurts the gums.”

Their heads tilted in different directions.

“Maybe you’re brushing too hard,” the speech therapist said.

The OT shook her head.  “SID,” she said, a little sad and a little curious.

I felt the muscle in my forehead scrunch tight.  “Brushing your teeth doesn’t hurt?”

They shook their heads.  My tense muscles suddenly deflated, bringing posture to my attention.  My torso was all squishy again.

“Okay, so what’s SID?”

When my little boy was born I couldn’t have imagined that through him, and his brothers, I would learn how to regulate my own body.  It never occurred to me that brushing one’s teeth wasn’t supposed to hurt or certain products could reduce the discomfort.  It never occurred to me that other people couldn’t feel individual strands of hair shifted by the “breeze” created by a door opening and shutting behind them.  It never occurred to me that the sound a fire alarm makes doesn’t shatter other peoples’ thoughts; no, my panic was always attributed (by me and others) to our house burning down when I was little.  I didn’t have low muscle tone as a child; I was weak, scrawny, and had bad posture.  Hundreds of little differences, and I would never have known but for my children.

Implications of Therapy

  • Posted on September 20, 2009 at 12:00 PM

Bev, of Asperger Square 8, has taken on an excellent project that has opened my mind to many new thoughts.  It’s called: A Checklist of Neurotypical Privilege.  While the entire document is worth reading (I highly recommend it) one piece stuck out and pricked me – mind, body and soul.

13. For a child of my neurotype, everyday teaching of the skills they will need to live in this society is called education or parenting—not therapy, treatment, or intervention.

The implication here is that for neurotypical children education is called education, but because neurodiverse students sometimes require different lessons, different teaching styles, and different techniques, their education is called therapy.

I consciously try to foster my children’s sense of worth and power.  I try to build them up so that they and others can better recognize their potential.  I do not, in any way, consider my children “less” because they are not neurotypical.  And yet, I never consciously thought about the implications of the use of “therapy” to describe our efforts to meet their educational needs.  The specialists who assist us in designing strategies and “interventions” to help my children learn are called therapists and they perform services that are funded as therapy.  I never once questioned these labels.  Now, after reading this document, thinking about it, and letting the issues it brings up fully penetrate my mind and my heart, I’m amazed and chagrined that it never occurred to me.  I’d long lost my comfort with the use of “intervention strategies,” which is a common phrase that’s applied to services intended to assist individuals with special needs.  But therapy always seemed completely innocuous.

When I think about the purposes of therapy, however, the point becomes clear.  The reason my children require therapy is because they do not learn all the things they need to know in a neurotypical manner.  Therefore, to teach them the things they need to know, we need to use different strategies, techniques, and behaviors to help induce learning.  Learning is still the goal.  So, whatever the means, teaching and educating are still the verbs.

Comparatively, consider the teaching strategies sometimes used with at-risk youth.  There are many, from charter schools to special programs, but they’re not called therapy.  These are children who often have neurotypical development, but face challenges not experienced by mainstream society.  To educate them as we should, we need to find ways to compensate for those challenges and this requires changes in teaching techniques.  In our language, we recognize that these differences and unfortunately we sometimes use language that denigrates the worth of the children, but we don’t call it “therapy.”  That’s reserved for students with disabilities.

Just as kids who perform below average or have problems due to their experiences, children who perform above average get specialized educational programs as well.  When I was a student, I attended classes that were labeled “differentiated.”  More was expected from me and my fellow classmates than our regular peers.  Specialized lessons were prepared for us and techniques were used to prevent the typical boredom children with above-average intelligence often experience in school.  It was differentiated, but still education – not therapy.

So, why do we use therapy to describe techniques used to teach students with special needs?  One obvious answer is that it hasn’t occurred to well-meaning people that the word might be offensive or inappropriate.  This is not a reason to continue using it, but it does explain part of the problem.  Like myself, there are others who have never considered the word might be controversial.  If this were the only barrier, change would be relatively easy.  Not genuinely easy, but more easy than it would otherwise be.  Unfortunately, this isn’t the only reason.  There is one good reason I can think not to change the use of the word.  Now, I caution you, it’s not a very good reason, in that it’s ethical or right.  It’s a good reason in that it benefits those the educational services are intended to benefit.

Simply put, the reason to keep the “therapy” label is funding.  Specialized educational services are expensive.  Funds are not readily available for these services.  In many American schools, the only reason these services get the funding the need is because it is federal law that they be available.  In many American schools, parents have to fight to get school officials to recognize that the services provided must be dictated by the needs of the child, not be the availability of resources.  This is a legal right won in the courts.  And it’s still an issue.  By changing the wording from “therapy” to “specialized educational services” one risks losing some of the oomph that “therapy” has.  Whether it’s accurate or not, whether it’s ethical or not, whether it’s true or not, “therapy” has a more respectable reputation with hints of medical necessity that “specialized educational services” lacks.  It’s all about shades of meaning here.  The research behind therapy and that supports its use is better funded and better supported than the research behind specialized educational services.  Programs for at-risk youth and for children with above average intellects are cut before students with disabilities, because the programs for students with disabilities have been propped up by law through the research that supports the benefits of therapy.  By changing the wording, you change the meaning in the minds of some of those you communicate with (which, admittedly is part of the point) in such a way that it’s detrimental to the programs being funded.

Now, again, I’m not saying that it’s a good thing that other programs are so easily cut from school budgets.  I don’t believe that.  I believe that all children, regardless of what their needs are, should get the educational services that fill those needs.  Society’s sense of the value of unique individuals has not progressed to that point yet.  By pushing for the human rights implications of education over therapy, I perceive a risk in damaging the fundability of those education services.  Ideally, the human rights implications would take priority.  They should.  But, the reality is that these services are often necessary.  I’m reluctant to advocate anything that would endanger their availability.

Which is not to suggest Bev’s document does any such thing.  I believe the purpose of the document was to open our minds.  If that’s true, then it certainly worked for me.