Connect with Success Podcast - Episode 7, Launch Date: June 9, 2021
With Dr. Rich Smith and Dr. Lynette Scotese-Wojtila
Subject: Socialization and Autism
Welcome to Connect with Success with Dr. Lynette Scotese-Wojtila where we help connect you with knowledge. Our mission is to lead you to a new and exciting way of understanding, responding to and helping all those with autism. We hope to expand your thinking about how to best serve these amazing people and how to support you in your daily struggles and celebrations.
Welcome to the seventh episode of CONNECT with SUCCESS podcast, built around The S.U.C.C.E.S.S. ApproachSM, and the person who coined it, Dr. Lynette Scotese-Wojtila. In episode six, we introduced the next foundational application to The S.U.C.C.E.S.S. ApproachSM, which was built around cognitive processing. In this episode we're going to build on this discussion by adding on socialization to the mix. Let's take a moment before we jump in to talk with Dr. Lynette about today's term for the show.
Dr. Scotese-Wojtila
Today's term is reciprocity, and what is reciprocity? Well, the long and short of it is basically, the pin pong of conversation, but it's actually known as the dynamic and reciprocal act of sustaining attention. And so partners sort of have to ping and pong in their conversation or in their discussions.
Dr. Smith
Alright so we're back with our message for today and I want to pick back up on this whole idea of what reciprocity is, but it tell us a little more about how reciprocity plays a role in childhood development.
Dr. Scotese-Wojtila
Well, it's actually a precursor to friendship development. So, when we have reciprocity in this back and forth dyad, if you will, between people we have relationships form. And there's something very interesting called mutual regulation, and it sounds kind of fancy, but what it really means is that my behavior socially impacts your behavior socially. So for instance if we are both neurotypical and we're having a conversation, my eye gaze, my gestures, my affect, my voice, everything is informing you to pay attention to my words and join in the conversation. And I'll pause and it'll be your turn. So there's this unspoken sort of ping pong. And while you're talking, I'm noticing your gestures and your inflection, I'm getting meaning from all of this sort of nonverbal expression. And we can regulate each other, to have a good conversation. But if we wanted to stop the conversation, if I wanted to impose upon you, that you stop, I might, consciously or sub consciously start yawning, or look away from you. And because you're picking up on my - what we call social pragmatic cues - you know, you're reading my attentiveness to the social information you're putting out, you would probably pause and say, “Gosh, I'm so sorry. Am I boring you?” or “Gosh, you seem distracted. Are you okay?” I know I've said the story five times.” I'll stop, you'd read me, you'd read my cues my social pragmatic nonverbal cues and respond. That's beautiful regulation we regulate each other in a conversation,
Dr. Smith
So is reciprocity a natural process for all people or specific to those in the spectrum?
Dr. Scotese-Wojtila
It's a natural process, it just in human development, but one of the precursors to reciprocity is something not so talked about. So let's kind of go back and say what underscores the capacity or the child's ability to have reciprocity and the answer is what we call joint attention.
So joint attention happens when there is a shared relevant stimuli that two people are attending to together. So a great example I try to tell people, and this is in my course as well. If you are the daddy of a three year old, and you're at the zoo and you have your three year old on your hip, and you're at the cheetah exhibit. You may take your finger and point to the cheetah way up either behind the tree or on the rocks or something, and turn to your child and say, “See? Way back over there? That's the cheetah! That's the cat.” Or whatever you're going to call it, and that child knows to kind of follow your finger, and as soon as they see it, but kind of like look back at you then back at the cheetah, then back at you, and there's like this triangle between your eyes, the child's eyes and this mutual subject of interest, and that beautiful joint attention which is this little triangular image we get is the precursor to common understanding, or common perspective, which is the precursor to reciprocity. You can't be reciprocal about a concept or an idea that you can't see, or understand that your communicative partner sees and understands, right.
Dr. Smith
So, why is it that those individuals with autism struggle with reciprocity?
Dr. Scotese-Wojtila
Well, I think part of it is that:
A) They're not good self-regulators. We talked a minute ago about mutual regulation, but they're not often self-regulated. That has to come before mutual regulations, so their bodies are not often in check. They might be revving high or they might be a little low arousal. They might be distracted and not kind of “in their body.” And so sometimes that's the reason that they're not even grounded to be a communicative partner. But if they are grounded and they are trying to communicate, they may not read the social graph pragmatic cues like I mentioned before, coming out of their communicative partner. And there's kind of this neurological reason or theory, that they are now exploring a bit it’s actually not that new; but to understand that, you first have to talk just a little bit about something called mirror neurons, and it's the brain term of course, but mirror neurons are the neurons that are in the premotor cortex, and they are responsible for our ability to perceive and understand the actions of others. And they're sort of like a “monkey see, monkey do” kind of a neuron and they help us to imitate. And studies have found like in 2011, that there's decreased, long-range connections that make these neurons not do their jobs very well, so it's actually a brain problem. And that study was produced by Mastofsky and Ewan (spelling?) in 2011. And so the behavior, the social behavior of people that have problems with these particular neurons, and the parts of the brain that process information from the motor neurons, really do struggle to understand and to read the environment well, and so they can't do “monkey see, monkey do.” They can't imitate a funny face. These are the kids that, you know, don't really have a good read, when there's somebody funny in front of them making a funny face, they don't know what sticking with a timeout means because they miss it. And so they can't do it back and have a funny reaction like some others where they have like a silly face war, you know. So, this is a neurological reason, it's not a choice, they're not trying to be aloof. It's one of the words I despise the most personally is the term aloof, because it's such an assessment kind of term of what the person maybe doesn't want, but it's not about wanting socialization, it's about understanding it.
Dr. Smith
Processing it, in general.
Dr. Scotese-Wojtila
Yes, processing in general.
Dr. Smith
So how does this fit in with communication? I mean this this is a heavy topic. The S.U.C.C.E.S.S. ApproachSM class is available online or in person, eventually. But right now it's definitely available online, self-paced, they can learn all about social pragmatic theory and communication. But just briefly, describe for us how does it fit in with communication?
Dr. Scotese-Wojtila
Well, first of all communication is theory dynamic. Again, this is from the field of speech therapy, we know that The S.U.C.C.E.S.S. ApproachSM has theories from occupational therapy, special education, psychology and speech therapy. And social pragmatic theory comes from speech language pathology theory and discipline. And any speech therapist would say that communication is very complex. There are different kinds of communication. There's nonverbal, there's pre-verbal, there is verbal, there's gestural, there are a lot of different manifestations of communication. But if we're dealing with a child with autism sometimes what happens is they don't have a second nature, or an automaticity, to their language. They have to think about the word or they don't understand the word. Or they understand the word, but something in the environment shuts them down from using that language well. And, you know, it's such a, language and communication is so paced. It’s so “ping pong, ping pong… initiate respond, initiate respond. There's a rhythm to language and communication. Right? And so a lot of our kids don't have that timing. Or they have delayed processing themselves, so a joke shared or a piece of information shared, gets missed on them, or they process it seven or eight minutes, or eight seconds rather, later than everyone else and so their timing is off, and that causes problems with reciprocity.
Dr. Smith
Yeah, I often see that my son loves to tell jokes and loves to tell jokes. But when he hears that it takes a minute for him to think about the punchline. And, you know, we'll prompt him with things like, “So you're thinking about what we just said, or I see you’re trying to think about what the punchline was.” And sometimes we have to explain it, and then once we explain it. It's funny, you know. But not being able to process things as fast as everybody else is totally on the mark.
Dr. Scotese-Wojtila
Yeah, which goes back to information processing theory because kids like him are struggling with the abstraction of the humor. Words have double meaning like we talked about in information processing theory. So if he only knows one meaning of a word, and the joke is a play on a different meaning of the word, it’s not funny, it's confusing. And so we don't see the humor that when we're confused, so I can relate to him when someone's telling a joke about something that's out of my wheelhouse, a concept I don't know, I can't relate to it. So we can really sympathize with having information processing deficits in the context of social pragmatic deficits, and how difficult it is to really, you know, quote unquote “fit in.”
Dr. Scotese-Wojtila
Right. And so where do you see some of the other struggles that you find the children are having with communication?
Dr. Scotese-Wojtila
Well they don't often have combined means, we talked about in the class and this is a good thing to look up on. You can check with your speech language pathologist and your pediatrician knows all these milestones as well; but a lot of kids don't meet their developmental milestones for speech development and communication because they don't have combined means. They can't be gestural and verbal and use their eye gaze all at the same time. Whereas neurotypical kids are telling you lots of ways what they want, in lots of ways; but there is also difficulty requesting or protesting or commenting, like other kids do for their age.
And, so it's pretty evident to some people that a child may want a favorite toy because the child is reaching for it and maybe seeing the name of the toy, sometimes children with autism don't have all those means. They might glance at it, and if you missed it, you missed it, you missed that eye gaze to that the toy, you missed that that's what they want. So they're not very full comprehensive communicators and that becomes difficult.
Dr. Smith
They are big thinkers.
Dr. Scotese-Wojtila
Big thinkers. They often know what they want, but they don't know that the world is watching them, and waiting for them to communicate to the world about it, because again, that perspective taking, that theory of mind that we talked about in Information Processing in episode 6 is missing. They don't know that they can influence someone else to know what they're thinking. And that's frustrating for them as well.
Dr. Smith
Absolutely. So what are some of the techniques that you, or parents have used, that you have found helpful in practice in helping students with their communication and reciprocity?
Dr. Scotese-Wojtila
Well, sometimes what we do is we help them to really be more solid in comprehending. So, there's two kinds of language, expressive and receptive. And the receptive language part is the comprehension part so we really want to shore up the child understands the meaning of words, the meaning of simple things like prepositions. We have a lot of kids that struggle with prepositions, things like “next to” “between” “beyond.” It's easy for us because we understand those directionality. But if you think about it, those terms are all relational terms to other things. So oppositely up when there's something beneath it. And so those terms are sometimes confusing so we definitely want to shore up receptive language and comprehension.
The other thing we want to help children on the spectrum know is that communication serves a purpose that is both functional and social. Research has shown that kids with autism tend to communicate for, sort of instructional, sort of, need-meeting content. So they will request something because they are hungry. Or they’ll identify something that they prefer.
They're not offering social information or saying Gosh, Dr. Smith, I really like your headset. They are not complementing, they're not noticing things that are out in the environment as much, because they're kind of into themselves, in the true definition of autism itself, by Leo Connor way back in the 1940s. That's sort of what happens, socially, they can't really think too easily about others it's, they're more likely to be in tune to their own needs, and so that's what they think about and that's how they respond.
Dr. Smith
And really they're trying to build that relationship to make those connections, so they start with themselves, to see if they can process it.
Dr. Scotese-Wojtila
That's right. And when they start with themselves, that's often where it ends too because they don't have that good brainstem integration we talked about in sensory integration theory. They don't have the opportunity to be good, mutual regulators in the context of socialization. So they're kind of stuck and they need us to meet them, like we would on the Gestalt cycle of experience that we talked about in Gestalt theory, join them on their cycle, so they can make contact with their world and socialize, or learn, or think, or perform, whatever they're required to do at that given moment.
Dr. Smith
Any final thoughts on communication reciprocity as we begin to wrap up the message today? Any other tips and tricks you want to give to parents?
Dr. Scotese-Wojtila
Yes, I think one thing we can do is use peers, you know, we don't oftentimes consciously remember that peers are great teachers. You know, we want to play, play, play. Social play is really important. And you can learn a lot about play if you're a child on the spectrum by being with kids who are not on the spectrum at things like a playground, or during a puppet show, or even just being in a social environment where you're playing with toys and how to navigate turn taking and sharing.
We really want our peers to be strong role models for our kids, but we also have to be responsible, so that those peers know how to slow things down and make the message salient for the child who's watching. And so if parents are motivated to do so, they can make little peer groups in their own communities and have what we call the “peer prop.” It’s kind of a funny term, in the terms of therapy, we'll call a “prop” a child who is there to learn from.
And so we might tell the child that, “We're going to have, you know, Jamie come in. And Jamie needs a lot of time to understand what you want to tell her, so when I say it’s your turn to talk, I want you to turn your body towards Jamie. Make sure that you're not moving your hands, that you're mostly talking, because if you start moving your hands, you're wiggling around, she's going to get distracted with your body, and miss your voice.
So you can engage these kids in very simplistic kind of instruction to really help the Jamies of the world to get the social content, little bursts at a time, and then it builds and builds and builds. So, social, or we'd say peer mediated play, is a really good tool if the person governing the children knows how to cue the kids well/
Dr. Smith
Especially since, and I can speak from experience here when your child starts to really build on that concept of finding that one best friend. And that whole idea of helping them to understand that these connections need to take place in order to build those friendships.
Dr. Scotese-Wojtila
One of the things that also is helpful, we're talking about peers, but another thing we can do, and we kind of talked about it with joint attention with my little example at the zoo, we as adults, and even siblings of our kids can go out of our way to model joint attention. So what that means is, if you're home, talking to your children as a group at the dining room table, and you hold up the mashed potatoes, and you say, “Look Dad, I have mashed potatoes. You see the spoon? The spoon is right in the middle, isn't it? And in that moment, your child with autism is watching you, and they're seeing that the bowl of potatoes is the centerpiece of both dad and mom's eyes. And as you're talking about the potatoes to dad, you can make sure that you're looking at dad. And then tell your child, “Now watch, I'm going to look at Daddy, make sure he's looking at me, and then we're both looking at the potatoes and we're going to look at Daddy. And then the potatoes.” You can model joint attention. That's a simple thing to do. I'm not saying go home and make dinner for homework, but any opportunity you have to point out what you are doing with your eyes and your voice. When it comes to sharing your attention is only going to help your kids know how to do it as well.
Dr. Smith
Yeah and I think for us as parents, it's a great reminder that everything is a teachable moment. We’re constantly on the stage and they're constantly watching us, especially those children who are on the spectrum, to try and make sense of the world.
Dr. Scotese-Wojtila
Yes, and in the analogy with mashed potatoes, they think about it, it's a beautiful thing to model but now what's so nice about a bowl of mashed potatoes is, you then quite, literally, share them. So the joint attention becomes a shared experience, and that is the beauty of reciprocity and using that ping-pong, ping-pong to intervention and to exchanges, it is really powerful.
Dr. Smith
So, the challenge for today, listeners, especially for the younger kiddos, is to try to watch for ways that you can establish joint attention with your child by first watching what they are attending to. And for our older folks on the spectrum, try to help them better regulate or reciprocate socially by modeling how to be both an initiator and responder to the ping and the pong in conversation.
Dr. Scotese-Wojtila
So coming off of our discussion on processing information and making connections we highlighted the next step in this episode on reciprocity and communication, and the importance of being purposeful during these social interactions. What are some of the other key takeaways from this episode?
Dr. Scotese-Wojtila
I would say we always want to remember that joint attention will lead to reciprocity, and that reciprocity leads to relationships, like friendships. We also want to remember that communication involves both responding and initiating what is meaningful information.
We hope that you learned something today to help you on your journey with autism. We'll share more on our next CONNECT with SUCCESS podcast.
Until then, expect success!
Dr. Richard Smith
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