Outcome of daily life nonverbal interaction, in two severely learning impaired children with different intervention programs: a longitudinal study

Affolter, F. & Bischofberger, W.

Presented at the XVth Biennial ISSBD (International Society for Behavioural Development) Bern / Switzerland July 1-4.

ABSTRACT

At age five both children were diagnosed as being severely learning disabled. They were inactive, visually oriented but did not perform any goal oriented sequence of topological changes as required in daily life events.

First period: For three years, they received guided tactual interaction therapy. Spontaneous interaction in daily life situations were video recorded and analysed according to event content, intimacy, little intimacy; situational conditions such as highly familiar, familiar, unfamiliar; information; and planning. By the end of the period they understood and performed familiar events in familiar surroundings with tactual-visual information, step-by-step.

Second period: For six years they received visual-auditory 1 verbal training programs. By the end of the period both children showed severe behavioral disturbances and were dismissed from their programs because of psychiatric problems.

Third period: For three years they received again guided tactual interaction intervention. By the end of that period both were integrated in a social environment, with adequate daily interaction.

PURPOSE

1. To investigate the use of several criteria for analyzing performance of daily life events to describe changes in behavior over time in children with learning disabilities.

2. To compare the outcome of different

ASSUMPTIONS

The model of a root to describe development appears to be applicable to normal children and to children with different disabilities; the root refers to tactual experiences in nonverbal interaction in daily life. It can be assumed that the growth of such a root is not adequate in children with severe learning disabilities and their development becomes not delayed but deviant. This means, one cannot simply wait, but has to provide for intervention at the level of the root.

METHOD

Both children, B. and H. were evaluated periodically for about 17 years: Boy B. was first seen at age 5 and was diagnosed as severe learning disabled and autistic. Girl H. was first seen at age 7 and had severe problems in language development. Both children went through periods with different intervention programs:

a) They received guided tactual intervention in daily life events for 3 to 4 years. b) This period was followed by a period of verbal/visual training intervention for several years: During four years, B. was in an a special program for autistic children based on behavior modification with verbal/visual reinforcements. Because of very severe behavior problems he was dismissed. H. followed programs of special education based on visual/verbal instructions for 6 years. Then H- began to fail in different professional programs.

c) Third period: guided tactual intervention in daily life events was again applied for several years, for B. in a special school program, for H. in different work settings, fast in a professional school for nursing

a) The criteria set up for analyzing performance in daily life events allow for description of changes of behavior over time in the two children.

b) Both children show regular improvement when receiving guided tactual intervention. They regress when receiving visual/verbal training programs.

Spontaneous and guided activities and test performance of the children were described and videotaped. Reports from the parents and educators served as additional sources of information. Five evaluations were selected over a period of 20 years.

Performances were grouped according to being oriented towards events of daily life, or not event oriented. For both kind of performances, the respective information conditions were described.

a) Not oriented towards events of daily life. Judged were:

The presence of interaction units: such as touching objects, grasping, releasing. For releasing, two, different patterns were analyzed, releasing with a kind of throwing, observable in the very young baby below age 7 months; and releasing with displacing, observable from 7 months on Topological changes: such as separate/putting together of objects. Moving: such as swinging, hitting head, climbing, throwing things around. b) Oriented towards, events of daily life:

Content of events: Habit, refers to sequences of actions which are always the same, with the same kind of material. Often, means the event happens not every day and not always in the same way, but often. New, refers to events which have not happened before. Events may require detours.

Surroundings: can be very familiar, e.g. the event happens at home; familiar, such as an event at school; unfamiliar, e.g. shopping in an unfamiliar store. The field of activity where the event happens may change, e.g., one has to go to another room to finish the event.

'Performance: daily life requires interaction units. Handing over, refers to giving an object to another person who needs it, e.g. giving a cup to another person who begins to open a carton of chocolate milk. Such handing over has two characteristics: the cup can be just pushed over the table to the other person, this is event oriented. Or, the cup can be pushed over, but the cup is turned so the other person can grasp the handle of the cup, this is person oriented. Comprehension, refers to a specific pattern which expresses attention and can be interpreted as comprehension, body tone and mimicry are not relaxed and not rigid, but show a certain tension over some time. Continuation of movements, can refer to the verbal condition, or to the guided tactual information condition, where the child is guided for the beginning of an event and the child continues. Spontaneous performance can happen in the visual information condition, and means that the child performs an event spontaneously without guided tactual or verbal instructions. Spontaneous production of events can happen step-bystep (A), or include detours (B) or some planning in advance (C).

c) Information conditions-. the child may receive guided tactual information, or the child may be given verbal instructions, or there may be visual cues the child uses to start an activity, such as a bottle and a glas on the table and the child begins to drink.

RESULTS

a) Observations of B. (see Table 1):

At both evaluations when visual information was provided, activities could be observed which were not oriented towards daily life: topological changes were separating at evaluation 1, separating and putting together at the end of the period, on evaluation 2.

There were no activities oriented towards daily life on evaluation 1, but on evaluation 2. At that time when he received guided tactual information, B. showed comprehension for events which happened often, in familiar surroundings, and releasing with displacing. When verbal/visual information was provided, B. performed habits but only in very familiar surroundings such as at home, and releasing without displacing, with throwing.

b) Observations of H. (see Table 2):

All activities observed were oriented towards daily life events. On evaluation 1, H. performed habits with verbal instructions in very familiar surroundings, all interaction units present. On evaluation 2 when H. received guided tactual information she showed comprehension and continuation of actions for new events with detours, in familiar surroundings, with changes in the field of activity and handing out oriented towards the person. When H. received verbal instruction she performed events similar to the guided tactual condition, except that the event had to happen often, and the handing over was oriented towards the event and not the person. When H. received no instruction, but visual information, she performed only habits, in very familiar surroundings and proceeded step-by-step (level A)

2. Period of verbal/visual training with evaluation 3 at the end of the period.

a). Observations of B. (see Table 1):

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Activities not oriented towards daily life events involved releasing with throwing, and with separating as it was observed on evaluation 1. Moving included an additional features, he would often hit his head. When verbal and or visual information was provided he often did not show comprehension even the events had habit character and happened in familiar surroundings.

b) Observations of H. (see Table 2):

For verbal information conditions H. showed continuation of actions; for visual information she proceeded step-by-step, and showed handing over event oriented; both only for habit events in very familiar surroundings. She also showed moving behavior in the sense of throwing objects or talking in phrases not event oriented.

3. Period of guided tactual intervention: evaluations 4 and 5.

a). Observations of B. (see Table 1):

There were no activities observable which were not oriented towards daily life. For moving he only showed some swinging. Receiving guided tactual information, B. showed comprehension and continuation of events which happened often, with detours, in familiar surroundings, with changes in the field of action, and handing over event oriented, see evaluation 4. On evaluation 5, new events could be included into the guided tactual condition. For the verbal information condition he showed comprehension and continuation for events which happened often, but with no detours, in familiar surroundings, but no change of field of activity and no handing over, see evaluation 4. Observations on evaluation 5 showed that detours and changes of field of activity were now possible.

For the visual information condition he showed step-by-step performance (level A) for habit events, with no, detours, in familiar surroundings, no change of field of activity, see evaluation 4. On evaluation 5, detours and change of field of activity were observable, and thus his performance became level B performance.

b) Observations of K(see Table 2):

When receiving guided tactual information, H. showed comprehension and continuation for new events with detours, in familiar surroundings, changes of field of activity, and handing over event oriented, see evaluation 4. Evaluation 5 showed that H. did not need guided tactual information anymore.

When receiving verbal or visual information, H. showed comprehension and continuation for events which happened often, with detours (level B), in familiar surroundings, with change of field of activity, and handing over event oriented, see evaluation 4. Evaluation 5 revealed that for verbal and visual conditions H. showed comprehension and continuation also for new events in unfamiliar surroundings with handing over person oriented. Thus, she could be grouped on level C for spontaneous performance of events.

DISCUSSION AND CONCLUSION

The results supported both hypotheses:

a) The criteria utilized here for the analyses of activities oriented towards daily life events, or not, allowed to describe changes in both children over time. b) There were marked differences between the periods of different intervention programs.

The changes during the first period of guided tactual intervention, from evaluation I to 2, can be interpreted as improvement. The changes during the second period of verbal/visual training, from evaluation 2 to 3, can be interpreted as regression. The changes during the third period of guided tactual intervention, from evaluation 3 to 4 to 5, can be interpreted ~" improvement.

Differences in performances in relation to the information condition showed, that improvement was first noticeable in the guided tactual condition, later in the verbal and visual condition.

TO CONCLUDE:

It is suggested that children with severe learning disabilities may need guided tactual intervention, otherwise they risk that their development becomes deviant.