This is a short book and contains nothing which is not already available in other books and videos by Caldwell. However; it does provide a useful outline of Caldwell’s ideas about what causes autism and an introduction to the idea of responsive communication, how one can communicate with people with autism. It will have value for those who are not familiar with Caldwell’s work, and with those who are but would like to find a succinct summary of some of the key ideas. The book is, as usual, well expressed.
Part 1 The Brainworld of autism
Caldwell outlines her view that autism is caused by deficits in sensory processing. The senses work and cognitive functions work, but data from the senses is scrambled on its way to the centres where sensory data is interpreted. Autistic people can easily become overwhelmed by too much sensory data. This is one of the main theories of autism, but is not the only one. Other theories focus on cognitive deficits, though there are different theories under this overall heading. The sensory theory still has proponents. (For example, Suzanne Zeedyk. [1]).
This reviewer is more inclined to the theory of mind theory of autism. This theory posits a particular part of the brain is responsible for reading the minds of other people, understanding and prediction their intentions and feelings. This particular part of the mind is not functioning in autistic people. (Upcoming articles and reviews will focus on this theory). Interestingly; it does not seem to matter for the effective practice of Intensive Interaction, the style of communicating with people with severe autism, which Phoebe Caldwell advocated, which theory you believe! Phoebe Caldwell is the leading expert on Intensive Interaction.
Caldwell summarises that traditional autism research has focussed on the triad of observable behaviour impairments; communication, play and social engagement, but more recent research is focussed on what is happening inside the brain.
Caldwell suggests that almost all autistic people have problems with the two areas in the brain linked to speech: Wernicke’s area (understanding written and spoken language) and Broca’s area (production of language). These may be damaged or they may not work in sync.
Caldwell’s strength is her depth of understanding of autistic people. In this book she is keen to remind us that “challenging behaviours” are usually actually distress behaviours. Someone is stressed beyond endurance and is suffering from a sensory overload. Caldwell discusses people using bad language. The problem here is that she wants to affirm to the person that she understands how they feel. The best way to do that may be to use the bad language back. “I know you feel fucked off”. But, organisational niceties can be a problem.
If someone is banging on a wall this could be an attempt to locate a physical boundary. Try giving them some physical pressure, or, if they are a child, holding them. A child who is torturing another one and making them cry may not be, in our sense, sadistically hurting them. The cries they hear may sound to them like a “beautiful symphony”. (Incidentally; this example seems to support the theory of mind theory; the autistic child simply does not see that the child who they are torturing is in pain). At any event; the key learning point for us, is how Caldwell really tries to understand how things are from the point of view of the person with autism. What is going on for them? What are they experiencing?
Part 2 Responsive Communication
By responsive communication Caldwell means Intensive Interaction working together with attention to sensory issues. This theme is explored in more depth in a book, Using Intensive Interaction and Sensory Integration [2].
Caldwell recapitulates her explanation of how Intensive Interaction works. When you ‘copy’ the body language and vocals including rhythm of a person with autism you are using semiology personal to them which is hardwired and very familiar to them. It does not need a lot of decoding. This reduces stress levels. When she uses a person’s own language with them, this is de-stressing for them. (I wanted to say ‘cooling’). They can turn their attention to these signs, which are happening outside of them, and this takes their attention away from their inner world of confusion.
Stimming, (repetitive actions such as waving your hands in a particular way), are what people resort to in order to keep confusion at bay, so they have at least one activity that has meaning for them.
If someone hits Caldwell she hits the nearest wall, to show them that she has got their intention. If she wants to go into the room of someone who is in distress she will stand in the doorway, point to her chest and point into the room and say at the same time: “May I come in?” She will then wait until they say yes or indicate that it is OK. Caldwell, elsewhere, emphasises needing to give agency to people with learning difficulties and autism.
Caldwell discusses some of her favourite case studies. This is very useful material for people practicing Intensive Interaction. She starts with observation, aiming to understand what is going on for the person at a sensory level. What sensory activity has meaning for the person. Caldwell emphasises that when practising Intensive Interaction it is vital not to miss a new element in the conversation which is introduced by the autist partner. If they do not get a response they may conclude that they are not really being listened to and will retreat back into their inner world.
It seems to this review that Caldwell’s key strength is that she is really fully attentive to her autistic partners. She observes them and tries to understand what is going on for them. In the conversation she is highly attentive to their every gesture and vocalisation, careful not to miss anything, and to respond always showing that she is there and listening.
First, we must learn to shift our focus from ourselves into the world of our conversation partner. We need to learn to empty our minds of our own concerns.
This book is a short but concise summary of Caldwell’s idea around autism and Intensive Interaction. It could serve equally well as an introduction to those who are not familiar with her work or a reminder for those who are already familiar with her work and who may be already using Intensive Interaction.
Autism. Respecting Difference. By Phoebe Caldwell. Pavilion. 2022
Notes
- Essay in Intensive Interaction. Theoretical Perspectives. Sage 2012.
- Using Intensive Interaction and Sensory Integration. Phoebe Caldwell and Jane Horwood. 2008. Jessica Kingsley.