Promoting Social Interaction for Individuals with Communicative Impairments

Making Contact

Suzanne Zeedyk

• Publisher: Jessica Kingsley Publishers
• Year: 2008
• ISBN:
  9781846427831
• Topic: Personal Development
• Subtopic: Writing & Presentation Skills

All humans have an innate need and ability to communicate with others, and this book presents successful approaches to nurturing communicative abilities in people who have some type of communication impairment.

The contributors look at a wide range of approaches, including intensive interaction, co-creative communication, sensory integration and music therapy, for a variety of impairments, including autism, profound learning disabilities, deafblindness, severe early neglect and dementia. This wide perspective provides insight into what it feels like to struggle with a communicative impairment, and how those who work with and care about such individuals can and should think more creatively about how to make contact with them.

Covering both the theory and practical implementation of different interventions, this book will be invaluable for health and social work professionals, psychologists, psychotherapists, counsellors, speech and language therapists, as well as researchers, teachers and students in these fields.

CHAPTER 1

INTRODUCTION: BRIDGING A SPECTRUM OF COMMUNICATIVE IMPAIRMENTS

M. Suzanne Zeedyk

We humans are social creatures. We need to engage with other people, to laugh with them, share stories with them, negotiate plans with them and sit comfortably in silence with them. There is growing interest, across a wide range of scientific and societal domains, in this process of human communication. Parents are urged to spend more time talking to their pre-verbal babies (e.g. National Literacy Trust 2007). Television programmes are made highlighting the long hours that elderly people spend isolated in the rooms of their care homes (e.g. Rage Against the Darkness 2004). Computer games are developed as a means of teaching autistic children the skills of making conversation with peers (e.g. Parsons and Mitchell 2002). Waiters are advised that they can earn more tips by speaking to customers in a certain manner (e.g. Van Baaren 2005). What a broad and disparate range of concerns!

The aim of this book is to counter that impression of diversity. Such issues are not disconnected and separate. They have an underlying base that gives them more commonalities than may at first be apparent. Recognising this unity across domains can foster both theoretical and applied insights. For example, understanding that infants are born already able to communicate with other people can help in designing more effective interventions for children with autism. Knowing that deafblind people have the (often unrecognised) capacity for complex conversational exchanges provides clues about the emergence of language in human evolutionary history. Reflecting on the ways in which we all sometimes feel anxious and short-tempered enables us to reinterpret aggressive behaviour in adults with learning disabilities as distress, rather than as violence. Such domains would normally be explored singularly, in books that focus on a specific domain. Our purpose in this volume is to take the opposite approach, bringing together a set of apparently diverse concerns within the same volume. We have two complementary goals in mind in doing so, the first being to share with a wider audience some of the scientific insights that interdisciplinary approaches to the field of human communication are yielding. The second is to illustrate how those insights are being used to develop novel interventions for communicative abilities that have become impaired.

The contributors to this volume come from a range of backgrounds. Some are practitioners who work regularly with clients with some form of communicative challenge. Their chapters offer wisdom gained from their practical experience. Other contributors are researchers, who describe the empirical studies that they have been conducting. Some of the work they discuss focuses on basic processes of human communication, while other efforts aim to systematically evaluate the effectiveness of intervention techniques. It is still somewhat unusual to bring together researchers and practitioners, because their terminologies and their concerns can differ remarkably, but we hope that the contents of this volume demonstrate the benefits that exist for both readers and contributors in crossing over traditional boundaries.

One might wonder how this mixed group came to be working together. The immediate background to the volume was a public seminar held in Dundee, Scotland, in 2007, entitled ‘Promoting Social Interaction for Individuals with Profound Communication Needs’, at which all of the authors presented their work to an audience of 150 people interested in the area of communication. The interest was more extensive than anticipated, with special needs teachers, mental health nurses, speech and language therapists, occupational therapists, care staff, parents, academics, students, and even musicians and artists attending. Feedback indicated that the most compelling aspects of the event for the delegates were links that they discovered with domains that they had previously had little familiarity with. For example, the challenges some faced in working with, say, children who had suffered severe neglect began to take on new meaning when it became apparent that similar challenges were being faced by staff working with elderly people with dementia. Many delegates also expressed frustration that the time constraints of the day meant that they could attend only a few of the workshops on offer. Thus this book was born, out of a sense that it would make the full content of the seminar available to all who were interested – not only those who attended on the day, but also an extended, international audience. This also meant that the investment made by the Developmental Section of the British Psychological Society, who kindly provided basic funding for the seminar, would yield even more dividends than they had hoped when agreeing to our initial proposal.

There is an even wider background to this book. Over the past five years an emerging network of researchers and practitioners interested in the topic of communication has become loosely affiliated with the Dundee area. A number of academic publications have emerged from the work of network members, most prominently a special issue of the journal Infant and Child Development, entitled ‘Imitation and socio-emotional processes: Implications for communicative development and interventions’ (Zeedyk and Heimann 2006), but this is the first opportunity we have had to direct our collaborative efforts toward a non-academic audience. It is an occasion that delights us, given that one of the aims of the network is to utilise research knowledge in developing innovative practice. We are grateful to Jessica Kingsley Publishers, who immediately saw the potential of this volume, despite the risks presented by its unusually broad content, which meant it had no easily identifiable market.

It is important to call attention to the broader scientific context within which our network’s efforts are situated. At the moment huge interest exists in communicative processes and their adaptions. In addition to the domains already touched upon, scientists are investigating whether primates create what could be called ‘culture’ (e.g. Tomasello 2001; Whiten in press), how marketing messages can be made even more persuasive through the incorporation of non-verbal cues (e.g. Bailenson and Yee 2005; Van Baaren et al. 2004), and the emotional (as opposed to cognitive) processes that underlie voters’ political decisions (e.g. Schreiber 2005). Within this intellectual flurry, one of the features of social interaction that has received particular attention is imitation. Three decades ago, developmental psychologists discovered (what many parents before them must also have discovered) that newborn infants, only minutes old, were able to imitate the facial expressions of adults, including sticking out tongues or forming an ‘O’ shape with their mouths (Maratos 1973; Meltzoff and Moore 1977). This seemed to be an innate, biological capacity that infants possessed for connecting to other people, although controversy has continued to rumble since the 1970s about the precise functions, structures and definitions of imitation (e.g. Anisfield 1996; Heimann 2001; Kugiumutzakis 1999; Meltzoff 2002; Nadel et al. 1999; Nagy 2006; Zeedyk 2006). Can infants that young ‘really’ imitate other people? If they can be said to be ‘connected’ psychologically to other people, does that connection exist at the emotional, perceptual, or mental level? Could such an innate predisposition have evolutionary roots, perhaps helping parents to bond emotionally with infants and thereby ensuring they would continue to give infants care and attention?

The debate surrounding imitation has recently intensified once again, upon the discovery by an Italian team of neuroscientists of what have been dubbed ‘mirror neurons’ (Rizzolatti et al. 1995). These are neurons (i.e. cells in the brain) that seem to fire both when an individual performs an action and also when he or she observes that action being performed by someone else. They were discovered in the brains of primates – apparently accidentally, when the electronic recording devices implanted in the monkey’s brain responded unexpectedly to the movements of one of the team members who was eating an ice cream cone. Mirror neurons have since been inferred as existing in the brains of humans. Such an overlapping function for cells, or perhaps cellular networks, implies that the connection between self and other may be so fundamental to human (and primate) functioning that it is neurally encoded. That is, interpersonal connections do not have to be learned through experience; our brains come equipped, from birth, with the ability to recognise them (Thompson 2001). The behaviours that have now been tentatively attributed to mirror neurons include yawning, the empathic identification with another person’s emotions, the spontaneous copying so often observed in young children’s play, the developmental imperative to acquire language, and even the experience of phantom limbs (e.g. Arbib 2005; Gallese 2006; Nadel et al. 2004; Ramachandran 2006; Ramachandran and Oberman 2006; Schurmann et al. 2005). Whether or not such proposals are eventually validated, the discovery of mirror neurons has reenergised the debate about imitation and has opened up revolutionary new spaces for the way that scientists think about human social, communicative and emotional capacities.

Evidence from the clinical and intervention literatures has much to offer this debate about the role of imitation in human functioning, even though cross-references between the basic and applied fields appear less frequently than one might expect. Empirical studies have shown that autistic children whose behaviours are imitated show unexpectedly high levels of interest in their partners (e.g. Escalona et al. 2002; Heimann, Laberg and Nordoen 2006; Nadel et al. 2000). The relationship between postnatally depressed mothers and their infants improves rapidly when mothers match their movements to those of their infants (Horowitz et al. 2001). Aggressive behaviour in adults with learning disabilities decreases substantially, and remains at lower levels, when staff respond to them using corresponding actions (Nind and Kellett 2002). Such findings demonstrate the need for scientists to think even more carefully about the inherent mutuality of human behaviour. Fortunately, such creative thinking is flourishing. For example, Jaak Panksepp has been for some time investigating emotions in animals as a means of better understanding human emotions (Panksepp 1998).

Ramachandran has recently speculated that many of the behaviours commonly associated with autism result from an ‘autonomic storm’ occluding the mirror neuron system, rather than from a fundamental disinterest in other people (Ramachandran and Oberman 2006). Alan Schore is one of many theorists now arguing that the ability of adults to read emotions in other people is grounded in the empathy that they received from others as a baby (Schore 2001; see also Sroufe et al. 2005; WAVE Trust 2005). These are fascinating and important avenues of investigation, for they aid not only in developing interventions to promote communicative abilities where they have become impaired in some way, but they ultimately help us to better understand the nature of our own humanity. That awareness lies at the core of the work being done by all the authors in this volume. They are each intrigued by the interconnectedness, the mutuality, that seems to be an essential component of our psychological and biological compositions as humans. A further aim for many of them is to understand how, by simply intensifying that mutuality – call the process what you will: imitation, reciprocal responsiveness, matching, speaking the other’s language, attunement, affirmation – it becomes possible to transform both one’s sense of connection to another human being and, simultaneously, one’s sense of self.

Seeking to institute some order onto what risks becoming an amorphous agenda, the book is structured in three sections. The first section provides insights into the origins of communication. In Chapter 2 Colwyn Trevarthen begins this exploration by describing the communicative capacities that babies bring with them into the world. During his long career as a developmental psychologist Trevarthen helped to generate a cosmic shift in science’s understanding of babies, for his data were among the first to show how very sensitive babies are to the behaviours of other people. His chapter traces the history of that discovery process, recalling the contributions made by a host of psychologists, brain scientists, anthropologists and others. What becomes clear is how momentous the change has been in our knowledge about the infant mind, and thus about the origins of human consciousness. We now know, for example, how important play and fun and joking are for the growth of the social brain. And we know that babies possess an innate sense of timing and rhythm, from which the human love of music derives. And we know, as Trevarthen so animatedly argues, just how misplaced traditional theories of human learning have been to assume that newborns possess only basic ‘biological’ abilities, maturing by merely processing information about the environment around them. It turns out that babies bring with them, from birth, the intuitive impulses with which they will make and sustain relationships, and through which the stimuli in their environment have any chance at all of coming to hold meaning for them. It is precisely these same intuitive impulses that interventions should be seeking to nurture in individuals with communicative impairments.

Raymond MacDonald develops these themes in Chapter 3, focusing on the ways in which adults retain such features within their communicative abilities. He focuses in particular on the musicality that is inherent within all adults – an awareness that arises both from his experimental research programme as a psychologist and also from his experience as a professional musician. The key point of his chapter is that music can be a particularly powerful means of connecting with other people’s emotions and intentions, often outstripping the capacity of spoken language in this regard. The research programme he describes has sought to demonstrate that enhancing individuals’ awareness of their musical identities supports their ability to engage with others. Thus he is essentially drawing attention to the multiple channels of communication that are often overlooked but nonetheless available to all of us, disabled and non-disabled alike.

The second section of the book examines five different ways in which communicative abilities can be impaired. In Chapter 4 Michelle O’Neill and colleagues focus on autism, a condition that alters the ways in which individuals engage socially, and one which has seen a worrying rise in prevalence over the past two decades. O’Neill reviews the literature showing that imitative responsiveness can be effective in promoting engagement, and then she describes work she has been doing, as a researcher, to teach parents to use imitative responsive techniques with their children who have autism. Her findings show that when these parents slow down and let their children take the lead in activities, using behaviours that correspond closely to the child’s movements and interests, children become much more solicitous and inviting of their parents’ attention. This is a major behavioural shift for these children, who are usually described as avoiding social contact. The attention to parents in O’Neill’s work is particularly valuable, for consideration of family members remains oddly neglected within large sections of the autism intervention literature.

In Chapter 5, Paul Hart focuses on the domain of deafblindness. Without the ability to see and hear the world around you, it is almost impossible to learn language, right? Wrong! What Hart seeks to show, as a member of a growing movement of rather radical practitioners working in this area, is that deafblind people can develop language – it is just that theirs is based in the main sensory system available to them: touch. More specifically, speaking a tactile language becomes possible for deafblind people when, and only when, they have available to them partners who are willing to spend time exploring their ‘spatial landscapes’. For with deafblind people, as with all other people, it is the mutual sharing of a landscape with other people that gives birth to representational linguistic skills. That cannot be done – there is no reason for it to be done – independently of social engagement. Hart explores the implications of this insight, both practically and the...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Contents
• Chapter 1. Introduction: Bridging a Spectrum of Communicative Impairments
• Part 1: Origins of Communication
• Part 2: Communicative Impairments
• Part 3: A Closer Look at Interventions
• The Contributors
• Subject Index
• Author Index