Please view the following publications by following the relevant links.
Barber, M. [2002] ‘The teacher who mistook his pupil for a
nuclear incident: Environment influences on the learning of people with profound
and multiple learning disabilities' in P. Farrell and M. Ainscow [eds] Making
Special Education Inclusive: From Research to Practice. David Fulton, London
to view
publication
Barber, M., [2001]
‘The Affective Communication Assessment; An owners manual’. PMLD Link
to view publication
Barber, M. & Goldbart, J. [1998] ‘Accounting for failure
to learn in people with profound and multiple learning disabilities’ in P. Lacey
& C. Ouvrey [eds] People with Profound and Multiple Learning Disabilities [A
collaborative approach to meeting complex needs] David Fulton London
to view
publication
Barber, M., (2002) 'Why
Do People With Profound Learning Disabilities Find It So Hard To Learn? - A New
Rationale' [to be submitted for publication)
to view publication
Barber, M., (2005) 'Intensive
Interaction: some practical considerations' PMLD Link
to view publication
Barber, M. [2006] ‘Intensive Interaction: Staying in the Grey’ PMLD Link (IN PRESS - to be published Spring 2007)
to view publication (PDF version) (Word document)
(Copyright of these texts rests with the author. Extracts or copies may only be made in accordance with instructions given by the author.)
The teacher who mistook his pupil for a nuclear incident:
Environment influences on the learning of people with profound and multiple
learning disabilities
Dr Mark Barber
An extended version of this paper is published in: Farrell, P. & Ainscow, M. [2002] (eds) Making Special Education Inclusive: From Research to Practice David Fulton Publishers, London
Background
Can we learn
about the experience of consciousness of a person with profound intellectual and
multiple disabilities (P.I.M.D.) by looking at catastrophic incidents in nuclear
power stations? It seems a ridiculous idea, but it’s not.
The Generic Error Modelling System (Reason 1990) or GEMS was developed following a decade of research into human error, and analysis of operator behaviours during catastrophic incidents in the power generation industry. It examines the interface between operators and the complex environments in which they work. GEMS leads to a perspective of consciousness and problem solving that appears to be very relevant to practitioners working with clients experiencing PMLD.
Reason (1990) presents a rationale of interaction that is based on three levels of cognitive involvement. Humans, he proposes, are always attempting to engage the environment with the least cognitive effort. Central to his approach is the principle that it is the environment which is hugely complex, and not our actions in it, and that humans can manipulate some types of information more easily than others. The fact that we can intuitively process the enormous amounts of perceptual data that allows us to drive our cars at 70 mph on a road that is hugely congested with other vehicles, but have trouble dividing 197 by 3.9 would seem to confirm this. However Reason (1987,1990) and Rasmussen (1983)(see also Rasmussen & Lind 1982; Rasmussen & Jenson 1984) account for this through the application of different levels of cognitive resources.
Skills, Rules and Knowledge
i) Skills
Routinised or habitual action involves the lowest or ‘Skill Based’ level of involvement of the cognitive resource. Here perceptually led, intuitive judgements are made about the state of our synchronised progress among the events around us. This level would include physical activities e.g. walking or riding a bicycle, where very little intellectual effort is required to direct our activity, although periodic ‘attentional checks’ (‘is everything ok?’) are made to ensure that our position in the flow of events is ‘as anticipated’ since the last check. ‘Attentional checks’ (Reason 1990) may be understood as momentary shifts from automatic to higher level processing, to ensure that actual performance matches intended performance and more importantly, that our stated ‘plan’ is still adequate to achieve its desired outcome. Following this perceptually informed ‘yes/no’ check, to confirm that our performance is within the limits of acceptable synchronisation, we return to our low maintenance, highly skilled activity. An example to illustrate this level would include an experienced cyclist travelling along a road, generally monitoring the largely empty road ahead, and very occasionally looking to see how far away from the kerb s/he was.
If however, our attentional check identifies that our execution of our actions has strayed from our intended route by more than that which can be reconciled by ‘within the plan’ adjustments, a ‘problem’ requiring more attention is perceived. This problem is referred to the next level of cognitive involvement, known as the ‘Rule Based’ level (Reason 1990). This referral would also occur if the attentional check identified that the circumstances in which we were acting were changing or about to change, forcing a new or adjusted plan to be used
ii) Rules
Rule Based level, comprises of responsive and recovery behaviours. This is the next higher level and it represents performance based on recognition of situations, together with rules for actions from our ‘know-how’. “The activity at the rule based level is to co-ordinate and control a sequence of skilled acts (Rasmussen & Lind, 1982). At this level, which is also known as the “level of flexible action patterns” (Zapf, Maier, Rappensperger & Irmer, 1994) well known actions are “specified by situationally defined parameters, and activated and integrated into an action chain pertaining to a specific situation” (Zapf, Maier, Rappensperger & Irmer, 1994). Decisions are taken on an IF <situation> THEN <action> basis : e.g.
if ~ the sink is overflowing then ~ turn the tap off.
OR
If ~ a possible communicative partner is close by then ~ attract their attention.
If, based on previous experience of similar situations, a rule or recovery plan can be easily identified, an action chain of skilled repertoires is used to resolve the problem so that Skill Based activity can continue.
iii) The Third Level
When ‘rules’ and contextually familiar signs are not available for a situation, i.e. the situation does not conform to any other remembered experience in the cognitive resource, it becomes necessary to generate a new plan for action ad hoc. This involves the third level of cognitive control, which is described as a Knowledge Based level (Reason 1990). This refers to what may be characterised as a theoretical knowledge resource. It is at this computationally powerful, but effortful level of cognitive involvement that active and conscious consideration of the whole problem is attempted. Involved only when recovery strategies have proved unsuccessful in re-establishing harmony between anticipated and actual problem configurations, this level of problem solving relates to an investigation of the problem at a conceptual level.
This rationale accounts for how problems are solved through ‘pattern matching’ (Reason 1987iii ;1990). Strategies and recovery plans are arrived at through monitoring what the problem looks like and using ‘what works best most of the time’. Decisions are influenced by the familiarity of the problem and previous experience. There are occasional difficulties when the plan or rule chosen is incorrect, or when a dominant environmental feature ‘captures’ the attention, or indeed when the execution of a problem is waylaid, at a choice point, by its similarity to another frequently used repertoire of behaviour. These problems account for the experience many of us have been through, when we set off to the shops on a Saturday morning, only to find ourselves in the car park outside our place of work, or when we go to the kitchen to check the oven, but find ourselves making a cup of coffee.
GEMS predicts that whenever an attentional check is omitted at a choice or node point, the most active (i.e. recently or successfully used) ‘scheme’ in the vicinity, because of shared content, contextual signals or frequent use, will govern subsequent activity. Reason compares the control of routine action to a “rather curious railway system where all the points are set by default to follow the most popular routes” (Reason 1987ii)
All very interesting, you may say, but how does this account relate to learners who experience PMLD?
Reason’s account of human interaction in complex environments relies on a massively interconnected cognitive resource. Problem solving and recovery strategies are arrived at through referencing problem configurations to previous experiences in similar conditions. Our choice of strategy, problem solution or recovery is influenced by what we used most successfully (and therefore memorably) on most other occasions that looked like this. ‘Feature led’ searches are made within the cognitive resource, of similar situations with the same significant ‘calling conditions’ that are also discriminated in the current ‘problem’, so that the ‘least worst’ match is arrived at.
Successful interaction in this model, relies on good information – the ‘agent’ must be able to discriminate the significant features of the ‘problem configuration’ so that a good match between problem and probable solutions may be made. Vague impressions of the problem, or a poorly stored memory of the previously applied solution leads to an increase in the probability that errors will be made. When information gathering channels are compromised, or when the storage (or recall) of memories or schemes is incomplete, the whole system that allows the rapid management of the vast amounts of data that we intuitively manipulate, becomes ‘data limited’. There is a threshold of information below which the system begins to flounder, leading the agent or operator, or indeed in this application; the learner, to reach the wrong conclusion about what is happening and the wrong verdict about what should be done.
PMLD and Data Limitation
Profound and
multiple learning disability (PMLD) or profound intellectual and multiple
disability (PIMD) can be defined as the combination of two or more severe
impairments, one of which is a profound learning disability (Ware 1994). There
is some agreement that this level of disability is experienced by fewer than 1
person in 1000 (Fryers 1986) although more recent studies indicate that the
prevalence of this level of disability is increasing (Male 1996, Ouvrey 1987).
Being among the most “difficult to teach” of students (Keogh & Reichle 1985)
they have been characterised as functioning at the “extreme lower levels of
cognitive attainment and adaptive behaviour” (Kaufman 1981) This description
reflects the fact that “such children typically acquire few self care,
communication, social or leisure skills. In short they are children with
extremely limited behavioural repertoires” (Remmington 1996). In addition to
PMLD, “ many of these children experience secondary sensory and physical
impairments or medically debilitating conditions (Rainforth 1982). Indeed
individuals with learning disabilities are up to 100 times more likely to have a
visual impairment than those without (Ware 1994) and the incidence of hearing
impairments in this population is reported to be around 40% ( Lavis et al 1997)
but may well approach 70% (Bunning 2001) depending on the method of audiological
assessment used.
The combination of hearing and visual impairment is a potent one, as the two senses interact with and supplement each other, providing information about important events occurring around the individual. Our visual field typically allows us to monitor about 45% of the space around us, leaving hearing as the sense that can pick up events occurring in the 55% of our perceptual range out of visual contact. Without hearing, then, events elapsing in our ‘blind spot’ are likely to go unnoticed. Our hearing also extends our vision. Significant signals that important events are about to happen are frequently discriminated through hearing – hearing a knock on a door, or the sound of the dog barking are both auditory indications that someone is about to arrive. Auditory detail could also be said to augment the visual information we discriminate, enabling us to attribute additional detail to what we simply see (e.g. whether an object is hollow or solid). Combined hearing loss and vision impairment then, appears to be a synergetic coupling, where the effect of the combination produces a greater loss, in terms of sensory information, to the individual than that which would result from a simple addition of the two individual impairments. It is uncontroversial then, to propose that individuals who experience PMLD can be described as ‘data limited’. In addition to the impoverished levels of information that they can discriminate and the frequent combinations of multiple sensory and motor disabilities, these people also experience profoundly compromised cognitive capacities which limits the processing, storage and recall of the information that they do perceive. (Barber & Goldbart 1998)
How GEMS relates to PMLD
The extended
experience of the combination of immobility, deprivation from environmental
information and limited cognitive processing can be seen to place obvious limits
on the levels of acquisition of the invaluable experience of physical
interaction with events. The memory of the successful encounters that do occur
can reasonably be judged to be vague (see for example Millar 1972) given that
the periods of time between wholly successful encounters may be considerable.
Compounding the poor levels of successful experience of encounters, social
experiences are frequently delivered to the disabled individual. The role of
people with PIMD in social encounters has been frequently documented as
developing quickly into one of ‘recipient’ of events, rather than one of equal
partnership (Brinker and Lewis, 1982; Golden & Reese,1996; Ware, 1994), where
partners negotiate the direction and meaning of an encounter “in order bring
events to their preferred conclusion” (Barber 2000) see also Grove, Bunning,
Porter & Olsson 1999.
By definition, individuals who experience PMLD have at their disposal extremely few behavioural responses with which to engage what is, a very complex and fluidly changing environment. Our perceptually driven, cognitive system typically ensures that we can engage fluid events and synchronise our movements with other occurrences within the frame of elapsing time, but it requires rapid information and diverse experience to work effectively. The interconnected operation of memory and recall ensures that approaching events can be ‘read’, related to intellectually stored previous experience and anticipated, so that we can join in what can be conceptualised as a ‘flow’ of events. Reason (1987iii ) expresses the ability to scan elapsing events as they approach, in order to decide which part of our surroundings to engage, as “placing one’s head in the data flow (i.e. monitored ongoing events) and waiting for a recognisable pattern to occur.”
To someone with only a hammer, every problem looks like a nail (Reason 1990)
It can be
surmised that individuals who experience profoundly impoverished levels of
information have extreme difficulty in achieving these operations. Indeed one
might conceptualise that the experience of a person with PMLD in these
circumstances would be similar to the experience of meeting a distant relative,
who you have not seen for a while, from a crowded, rush-hour train. As you
stand at the platform gate, the train disgorges its passengers, who approach you
as a heaving myriad. Your task is to identify the familiar individual, who you
have been told is wearing a red coat. Similarly, an individual with PMLD is
faced with the task of recognising situations among the host of events around
them, in which they can apply their few successful behavioural repertoires.
Frequently, by the time a promising opportunity to engage (eg) a passing staff
member, or carer has been identified, the opportunity is passed and the disabled
individual must again scan for interactive opportunities.
Once a familiar opportunity is recognised, further difficulties occur. The logic of GEMS suggests that for someone with few interactive repertoires, the primary problem is to identify situations that their limited interactive repertoires may be applied to. To someone with only a hammer, every problem looks like a nail; for people who have very little experience of engagement in successful encounters, the problem of identifying a strategy or interactive scheme to match current the calling conditions of their surroundings becomes insurmountable. The few schemes they can successfully ‘deploy’ to meet an opportunity may not correspond to the calling conditions of the current situation. A pupil who can eye point or smile, but not reach or produce controlled vocal sounds cannot effectively attract the attention of a teacher who is not looking at them (Barber Goldbart & Munley 1995). Thus, the critical issue is not the repertoires of the disabled individual, or ‘what they can do’ but whether these schemes are appropriate to the opportunity at hand. ‘It is not the flexibility of the learner’s skills that enables interaction to occur, but the flexibility of the situation that allows the inclusion of the learner. (Barber 2000)
For the majority of their day, clients and pupils with PMLD do not experience either a controllable or responsive environment (Ware 1996 Barber 1994). This is not improved by the types of interactions in which they are involved. The ‘social’ interactions that individuals with PMLD do appear to encounter have little about them that distinguishes them from the background presence of other elapsing events that occasionally include the individual with PMLD, and distract them from internal ‘state’ awareness. The isolation from controllable events that many multiply and intellectually disabled people experience for much of their waking hours has already been identified as leading to learned helplessness (Seligman,1975; Berger & Cunningham, 1983) and ultimately to what Brinker & Lewis (1982) termed “a deprivation from contingencies”. It is understandable therefore that in the face of what must appear to be a frequently chaotic and largely unpredictable physical and social environment, that many people with PMLD orient progressively more to the sensory experiences that they can generate for themselves.
It is proposed that the distress that many individuals show when they are included in social encounters derives from the fact that teachers and therapists are frequently disturbing their clients from their controllable, predictable and pleasurable sensory experiences. Indeed the arrival of a staff member can easily be seen to be an experience of mixed emotions for the client, who cannot be sure if the approach signals that they are about to be moved into a different position, to be fed, to be changed, to be placed in some therapeutic equipment, or to be involved in an activity in a different part of the room, or indeed building. The agendas of staff and therapists going about their business are a closely kept secret from the perspective of the individual who cannot recognise the subtleties of a room management timetable. Thus, the clients’ experience of interaction may be seen not as one of negotiation, or domination over events, or of moving to place themselves in their choice of the various elapsing sequences of events to bring them to preferred conclusions. The clients’ experience may be more akin to monitoring and accepting elapsing events and acting on them as they change to present a configuration which allows them to interact within it.
The increasing requirements of the environment
There is
evidence that clients with PMLD do make successful decisions and choices about
the relative responsiveness of the opportunities that are open to them, but this
is largely limited to choices of object focussed as opposed person focussed
exchanges with the environment (Barber 2000). When the clients became involved
with social interactions, the transactional requirements appeared to be too
great to support their strategies unless richly interpreted meaning is routinely
assigned to their actions by their communicative partner. Micro-switches after
all, are either ‘off’ or ‘on’, and although actions directed to them can
increase in frequency, more sophisticated relationships with them are impossible
to achieve. Thus, increases in the frequency of behaviours addressed to switches
do not necessarily demonstrate increased cognitive activity. Whereas encounters
with communicative partners can quickly spiral in complexity, leaving the
learner unable to maintain their part of the dialogue.
There has been an notable focus, by researchers, on the characteristics of profoundly intellectually disabled learners’ use of the hierarchy of communicative functions described by Bruner (1981) as initiation to regulate the behaviour of others (IBR), initiation to achieve joint attention (IJA) and initiation to achieve social interaction (ISI) (Carpenter, Mastergeorge & Coggins, 1983; Cirren & Rowland,1985; Park 1997; Sugarman-Bell 1979, Wetherby & Prizant 1992). This is closely related to descriptions of protoimperative and protodeclarative functions made by Bates et al (1979) and ‘simple’ through to ‘coordinated’ orientations described by Sugarman (1978). A number of these studies, reflecting the progression through these communicative hierarchies note that severely and profoundly learning disabled individuals appear to have difficulties in acquiring the apparent ‘critical mass’ (Barber 2000) of experience that enables protodeclarative or joint attention functions to emerge (Cirren & Rowland,1985; Park 1997;Wetherby & Prizant 1992). Viewing the environment in terms of data flow could shed some light on this issue.
When an individual communicates in order to regulate the behaviour of a communicative partner, the dialogue is frequently motivated by the urge to satisfy an emerging need. This communicative function can be viewed as the use of another person to achieve a task outside of the physical ability of the communicator. An eye point to a full cup, might be interpreted as a request for a drink, or stretching toward an out of reach toy might be interpreted by the viewer as a request by the communicator, to the skilled partner to bring the toy within reach. Responses to these actions are easily accomplished, resulting in the delivery of the drink or the toy. In this case, the communicator has ample evidence that his or her attempt to control another person was successful. The skilled partner approaches, the thirst is quenched and the cup is empty.
But when the communicator attempts to attract the attention of the skilled partner to something of interest to them (IJI), e.g. a sparkling piece of jewellery that catches their attention, evidence that the initiation has been successful is more subtle: The partner may approach and acknowledge the attention getting behaviour of the communicator, but realistically, because of limited social signalling, or difficulties that the communicator has in directing their partner’s attention, the partner may well be unsure of the focus of the communicators attention. In the absence of anything obvious (e.g. a drink or near by object etc) the partner will frequently assume that the communicator is drawing their attention to some other need, alternately that they are mistakenly identified a communicational attempt. We do not look for what we do not expect, but repeatedly anticipate our client’s needs based on our knowledge of them. Whether attention is successfully directed or not, the evidence for the communicator, that their attempt was successful, is less obvious and therefore more complex.
To successfully discriminate that social interaction has been successfully initiated is even more difficult for someone with PMLD, as within this function there is no necessity for any physical joint focus for attention. As with the previous function, it is likely that in many cases, the meaning of the communicative attempt is not clear to the partner (see also Grove, Bunning, Porter & Olsson 1999)
Following the GEMS perspective, we do most what we do best. The selection and use of a repertoire or scheme depends on how ‘active’ (Reason 1990) or prominent it is in the cognitive resource. Its position, relative to other schemes, depends on how successfully it has been used in previous, similar circumstances. If there is good evidence of the success of the use of IBR, but the discernible evidence from IJI or ISI is vague or ambiguous, the style of engagement most likely to be used in the presence of an available partner will be the more successfully discriminated IBR.
Over time, the ‘Deployment Bias’ (Reason 1990) or the tendency to look for anticipated ‘signs’ at the expense of those which are less reliable, and ‘frequency gambling’, when one thinks about forms of action that had been repeatedly used in the past, will lead to the learner to use the style s/he experiences most success with.
To assure its re-use, it is vital that the learner can discriminate that a rule or scheme was successful, otherwise reselection is unlikely. Placed in the context of a diverse cognitive resource, this process typically establishes the most efficient and successful schemes to enable us to engage our fluid environment, but in the context of limited cognitive and physical resources, it further narrows interactive possibilities.
Implications
Accepting
this approach, one is led to identify that the central problems for individuals
with PMLD and multi-sensory impairments (MSI) include
·
recognising
available interactive opportunities that correspond to
their behavioural repertoires,
·
acquiring successful
interactive experience and
·
maintaining and
extending interactions once they have been
initiated.
The ‘system’ cannot run smoothly without easily accessible sensory information and successful involvement in diverse encounters.
In the face of an unfamiliar problem, the data limited problem solver is likely to compare current conditions to past encounters and pick the ‘least worst strategy’ (Reason 1990) or action scheme that is identified from what is, in this application, a profoundly compromised cognitive resource. If the fit between strategy and configuration works and involvement is achieved, the increasing ‘transactional’ (Sameroff 1975; Hewett & Nind 1998) complexity of the encounter either leads the learner to repeat the successful strategy to achieve a recognisable event rather than varying, or trying to refine it (i.e. by increasing the level of its complexity) and risk losing the sought after, recognised environmental response. Alternatively, the environmental or social response to their attempt at interaction demands further involvement, that requires responses that are not maintained in the learner’s resource of repertoires
To enable the learner to remain involved, the environment and social targets are required to have immense flexibility, responsiveness and availability. Events need to be signalled so that the learner recognises them i.e. the ‘features’ of the encounter correspond to easily recognised features of previous successful interactions. Rather than simply responding to social encounters from skilled others, learners require the experience of establishing the topic of the interaction. This would allow them to perceive that events can respond to their actions in a controllable manner, rather than becoming more complex or unpredictable, or more subtle and thus, indistinguishable from the rest of the data flow. Vygotski’s (1962) notion of the skilled partner “intermentally”, supporting the learner to success by “scaffolding” the difference between what the learner can do and what success in a situation requires can be seen to have great relevance to this perspective.
Small Islands in the Chaos
This approach
provides therapists and special educators who design interactive encounters that
involve their clients and enable them towards increased control and
assertiveness in the environment to consider a number of important issues. When
engaging their clients, are they more interesting than the events clients can
generate for themselves? When they respond to their client’s behaviours or
encourage them to interact with objects, are they increasing the requirements of
the engagement more than the client would prefer? If their client ‘codes’ them
more as an interesting event than a social contributor, are they just becoming
unpredictable and therefore less accessible, when items that the therapist
thinks will be interesting, are brought in to the encounter? Accepting that a
large proportion of our client’s day is beyond their control, therapists and
educators should ensure that their time spent together with learners should at
least be predictable, recognisable and responsive. The increasing complexity of
the transactional environment presents huge problems not only to the disabled
learner, but also to the ‘skilled’ partner. How, practically, does one limit
the complexity of an encounter, but maintain the clients focus and motivation to
interact?
A style of interaction that responds to many of the issues raised in this article can be facilitated by teachers and therapists working with people who have extremely compromised cognitive and physical resources. By providing frequent experience of social encounters that are guided or scaffolded to emphasise communicative processes, the communicative significance of their own behaviours can be highlighted: Physical or vocal turn-taking dialogues can be guided into imitation, where the variation in the skilled partner’s actions, will respond to the behaviours of the learner, who in turn, perceives an event that responds and varies contingently with their contribution.
The level of social responsiveness and flexibility involved in this style of interaction has been noted to increase signs of positive affect (Nind 1993) in “hard to reach” clients and is being increasingly recognised as, when compared to many other approaches, a “least worst” (Reason 1990) style of scaffolding and facilitating experience of successful social interaction.
To separate our attempts at communicating with clients from the rest of the frequently unpredictable data flow that they experience, it seems logical to identify them by sign-posting or signalling the encounter. This can be seen as carving out an ‘island in the chaos’ so that the client will recognise that for this part of the day, the encounters in which they are involved will respond to their contribution and can therefore be engaged successfully. Greetings or initiations at the beginning of encounters might involve appropriate touch, proximity or responses that are consistent and recognisable to the client. Thus, their ‘feature led searches’ are provided with clear, discriminable information to activate more accurate anticipation. Although responding to the client’s contributions, the skilled partner can usually guide encounters so that over time, repertoires or interactive routes can be developed, negotiated and later anticipated or initiated
Facilitating encounters so that they occur in response to client’s repertoires rather than in response to intervening practitioners, effectively places a ceiling on the increase of complexity of the interaction. Although a responsive social event may actually be perceived or ‘read’ as a contingent response or “procedure” (Uzgiris & Hunt 1975), the learner can be maintained in a successful interaction because the environmental requirements are not rigid. Teachers and therapists can facilitate social encounters that respond to the actions and perceived intentions of the client, so that in effect, their repertoires and signals correspond to the requirements of the environment. The practitioner therefore accepts the client’s repertoires, and rather than attempting to increase their complexity, constructs interactions around them.
The skill of the facilitator then, is to ensure that all of the problems that the learner will encounter during a social encounter, can be solved, or at least can be engaged, with just a hammer.
Note: I would like to thank Dr. Juliet Goldbart [Manchester Metropolitan University] for her advice during the writing of this article.
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