EE and JE are two brothers, age eleven and eight respectively, who attend the same mainstream primary. Both children were identified as having difficulties considered consistent within Autistic Spectrum Disorders (ASD) and therefore each was issued with a Special Educational Needs (SEN) Statement. Both children have recently started to experience social, emotional and behavioural difficulties (SEBD) at an intensity which is of great concern for those professionals working with them. A more detailed description of these difficulties will be outlined in the following section.
The school they attend opened an ASD Resource Base (RB) in September 2009. The siblings have been timetabled in the Base according to their language and cognitive developmental levels. They were mapped for this wave 3 intervention with the view of increasing their successful inclusion in the mainstream educational offer. For EE, initial assessment lead professionals to allocate 60% of his school time in the RB, along with eight other students of different ages but similar educational needs. All nine children have been assessed within P Scale levels (QCA, 2005). JE's learning difficulties are of a moderate nature and therefore he was grouped in a different ability group with other three students. All children in this group were assessed to be working at National Curriculum level 1. JE's group was scheduled four weekly sessions in the Base with the view to provide additional support in the development of the children's Literacy, Numeracy and Social/Emotional skills. All teachers involved in their education are developing a shared understanding of the use of Provision Maps (PMs), personalised documents that provide an overview of the children's allocated wave 2 and wave 3 interventions, as well as their long and short term educational targets. PMs are used to inform teachers' planning, both in the mainstream classroom and in the RB. In addition, they provide staff with a shared understanding of each child's educational needs (Gross, 2008). PMs also contribute to the school's inclusive ethos, supporting Rieser's (1995) proposal that SEN should be part of the school's equal opportunities policy rather than being considered as a separate issue (cited in Cowne, 2000). Any child on role at this primary can access to the provision that is additional to or different from the mainstream offer at any time their needs indicate so, whether they present with SEN or not.
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The purpose of this essay is not necessarily to challenge the subjects' ASD diagnoses but to analyse the nature of the behaviours they are currently manifesting, which may provide some relevant explanations and result in useful interventions once and if attachment disorders are considered. Johnson (1992) and Williams, O'Callaghan and Cowie (1994), authors cited in Geddes (2006), maintain that children's attachment experiences have implications for those seeking to support them in their learning process. It is the author's assumption that the two boys in this study are using behaviour as a way to communicate their emotional needs. This essay will attempt to give meaning to their current behaviour using Geddes' 'Learning Triangle Theory' (2006) and apply this analysis to inform future practice.
Recent behavioural changes in both siblings if considered jointly may contribute to critically identifying possible parenting issues, which could prove significant as both children are currently being assessed as potentional candidates for the Child Protection Register.
Identifying Problem Behaviours: an outline of background information and recent behavioural observations.
EE is the eldest of the siblings and will be moving to secondary education in September 2010. He was diagnosed with ASD when he was almost 3 years old. EE presents with severe difficulties in the three areas of development which constitute the 'triad of impairments' at the core of the autistic spectrum: social and emotional understanding; all aspects of communication; and flexibility of thought and behaviour (Jordan, 2005). During his primary education, EE has been known as a compliant boy, very quiet and tranquil. He tends to keep to himself but responds well to adult lead activities. He finds it hard to stay focused on activities that are not of his own choosing but understands boundaries and responds well to positive behavioural management approaches used with individuals with ASD, such as making connections with key adults, clear expectations, and verbal praise (Kluth, 2003). Over the past two months, EE has shown increasing signs of anxiety in response to other children suddenly becoming upset. On one occasion, a little girl in his RB group accidentally hurt herself and began to cry inconsolably. The change in his muscle tone was very apparent to those working with him. He became very rigid and placed his hands on his stomach. After a minute or two, and once the girl had calmed down, EE asked to go to the toilet, which he never had done before during lesson times. While it is reported that EE has been receptive to criticism in the past, he is currently very sensitive to any sign of disapproval, getting easily upset if he feels he is in trouble and often denying any wrongdoing. If another child hurts him/herself and a graze is apparent, EE tries to communicate the incident to an adult. He has begun relating these incidents to his own experiences, intentionally expressing these connections to the adults working at the RB and consequently disclosing events of concern. He has pointed at scars on his body while naming his brother. When asked what happened, EE usually responds "mummy slaps JE". EE's language difficulties are a barrier to him expressing his needs and historically he has not initiated a conversation with another person. The contexts in which EE feels the need to share his own thoughts are related to others or himself being in physical pain. Recently EE's appetite has also worsened and he is reluctant to join in at snack time, having to be regularly encouraged to eat. It would then seem reasonable to consider EE's behaviours, such as the changes in his appetite, noticeable anxiety and withdrawal, as symptoms possibly associated with a specific emotional disorder, such as depression or anxiety (DfEE, 2001).
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JE is a year 4 student and the second child of what is about to become a family of four siblings. JE also was diagnosed with ASD at the age of four. He has always had a very loud and active nature. His language impairment is more apparent in his expressive skills, especially when involved in some kind of conflict with his peers. JE is known for his tendency to be non-compliant. When contradicted or challenged, he initially would protest verbally, but would comply with key adults like his teacher or LSA. He had not shown any physical aggression until two months ago. JE regularly appears in a heightened state of anxiety and he has become increasingly negatively fixated on one particular child, with whom he has experienced difficulty interacting with throughout his schooling. His sensitivity to criticism has accentuated recently and his difficulties in initiating and maintaining positive and trusting relationships with both peers and adults are escalating. JE's most challenging behaviour is his determination to always be in control at whatever the cost, both in class and at playtimes. He appears increasingly restless and has expressed lack of sleep. The nature of JE's SEBD is gradually proving more challenging to those working with him, to the extreme of being at risk of permanent exclusion. He is developing a pattern of "flight and fight" (Geddes, 2006), demonstrating an increasing violence against school property and/or adults. Physical restrain is met with spitting, kicking, punching, and even with the shouting of false accusations. Sometimes the trigger to his outburst can be peers succeeding in tasks or behaviours which he has declined to attempt himself. At other times, the outburst occurs when he has been denied permission to go to the toilet or to access to a preferred activity. His ability to remain on task is deteriorating. When a member of the mainstream staff referred to calling his father to report his behaviour, JE begged for it not to happen, alegating that his father would "hit him with the belt". Despite knowing of his tendency to lie, the leadership considered all recent developments involving both siblings, and the school's child protection officer referred their case to Children Services.
Circular 9/94 (DfEE, 1994) defines (S)EBD as difficulties presented in a continuum between behaviour which challenges teachers but which can be considered within normal developmental bounds and that which is indicative of serious mental illness. In EE's case, the behaviours he is presenting could be considered typical within the autistic spectrum, yet it is the sudden change parallel to those observed in his younger brother that has alerted professionals working with him, triggering a multidisciplinary analysis of the possible causes underlying these behaviours. JE's disruptive and disturbing behaviours, the deterioration of his social skills and his escalating distress, have lead the author of this paper to consider a possible overlap between his SEBD and mental health difficulties (SEBDA, 2006). It would appear that his current case scenario fits within the DfES (2001) definition of conduct/anti-social disorders:
"Conduct disorder is a term used by mental health specialists to describe a syndrome or core symptoms, which â€¦ involve three overlapping domains of behaviour: defiance of the will of someone in authority; aggressiveness; and anti-social behaviour that violates other people's rights, property or person".
(DfES, 2001 p.24)
A referral to Children and Adolescence Mental Health Services (CAMHS) followed this hypothesis, but in the interim that assessment is undertaken by the designated professionals, staff involved with JE's education relates to Geddes' (2006) assertion of the practitioner's need to reflect upon the effect that he is having on those working with him. Professionals agree that the severity of JE's behaviour at times of crisis appears to be negatively affecting professionals' ability to think and respond using best practice, thus the system is becoming reactive with an increase in punitive responses and fixed term exclusions. JE is gradually becoming more rejected and unpopular amongst his peers and the adults around him, which is having a detrimental effect on his self-esteem and consequently his academic performance is decaying hastily. Difficulties in interpersonal relationship skills correlate highly with self-esteem, affect school performance and other psychosocial domains (Dana, 2009). JE's emotional and social difficulties seem to be spiraling within Dana's assertion. Greenhalgh (1994) emphasizes that for those children affected with emotional and behavioural difficulties, their ability to learn is strongly linked to the children's ability to relate to others. His assertion could be then considered in connection with the pioneer work of Bowlby (1969; cited in Bowlby, 1988) on Attachment Theory. Bowlby explains attachment behaviour as a set of behaviour patterns meant to develop during the child's early months of life. He adopts an ethological approach to the understanding of parenting and identifies the need for protection as the reason for the development of attachment between infant and caregiver. Attachment can be explained as the emotional bond that develops between the two, providing the infant with emotional security (Peardy, 1998).
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Cooper, Smith and Upton (1994) considered that behaviour problems in schools could be caused by the emotional difficulties emerging as a consequence of difficult family backgrounds or physical/sexual abuse. Ainsworth's experiment called "The Strange Situation" (1978; cited in Geddes, 2006 and Pearce, 2009) contributed to the identification of the essential input of the mother's sensitivity to her infant in the development of attachment patterns. It is reported that JE's social and emotional difficulties, specially his inability of developing trusting and long lasting relationships, have always been present during his schooling, but has taken a more anti-social direction in recent times.
Prior to critically analysing the attachment patterns observed in the teaching and learning environment of the RB - thus the individuals' SEBD can be analysed under the Attachment Theory framework -, it appears relevant to first consider the Attachment Theory in relation to children diagnosed with autistic disorders.
Attachment patterns in children with ASD.
Parenting children with ASD can be highly stressful (Koegel et al. 1992 and Dum et al. 2001; cited in Rutgers et al. 2007). Rutgers et al. (2007) explain how a number of researchers maintain that impairments in social interaction may have their impact on parental interactive behaviour, suggesting that parenting is particularly affected by the child's lack of adaptability, his/her demandingness and the parents' acceptability of the child's disability. Despite this fact, Rutgers et al. (2007) conclude that children with ASD are able to show secure attachment behaviours to their parents regardless of their impairments in social interactions. The results of their study, also indicate that children with ASD who present with attachment disorders, follow a disorganised/disoriented pattern. Pearce (2009) describes this pattern as that defined by the children's bizarre and contradictory behaviours towards the caregiver, exhibiting incomplete movements and poor affective displays. Rutgers et al. (2007) attribute the cause of these differences to the detrimental impact that the children's social and language impairments can have on their parents' interactive behaviour, especially when the children have severe difficulties in conventionally displaying their emotions. These authors maintain that with children with ASD, more sensitive parenting is not necessarily associated with more attachment security, whereas for children without ASD, more sensitive parenting is associated with more attachment security. These findings could be significant when identifying differences in the possible underlying causes of the siblings' current SEBD.
As outlined in the introduction of this essay, the aim of this present analysis is to underpin possible connections between the subjects' SEBD and what Ainsworth et al. (1978, cited in Geddes, 2006; Rutgers et al. 2007; and Pearce, 2009) referred to as insecure patterns of attachment. Before considering possible attachment disorders as possible causes of the children's SEBD, the siblings' language difficulties have been taken into consideration. Teaching staff consulted the RB Speech and Language Therapist (SALT) in relation to a possible link between the children's recent change in behaviour, their communication disorders, and their self-awareness. Law and Garrett (2004) cited the work done by Baker and Cantwell (1985) in order to determine the exact nature of the relationship between behavioural disorders and communication disorders. These authors concluded that early communication difficulties and behavioural problems are integrally linked in a common developmental trail that may become stronger as the child grows older. Both children have been receiving language therapy at school and since the opening of the RB, the hours of direct contact with the therapist have increased. During the first weeks of the school year, both children shown better than expected progress in all academic areas and SALT reported considerable improvement in their language and communication skills. Both children are demonstrating a strong need to communicate. Whether this need is to point at what is upsetting them or to link their present experiences to other environments is unknown. In consultation with the SALT, and in terms of their language development, it was agreed that both children are making good progress. It was then assumed that answers to the subjects' change in behaviour needed to be found elsewhere.
Understanding the nature of early experience and its disorders in the classroom could help staff understand the meaning of the children's behaviour in school and indicate what kind of response and intervention may be effective (Geddes, 2006).
Attachment patterns observed in the classroom: differences between the two siblings.
Clements (2005) asserts that behaviour is driven by interactions between the individual and the environment, adopting an ecosystemic approach when understanding behaviour in children with ASD. Attachment Theory is yet another ecosystemic framework within which professionals have the opportunity to view pupils and their social and emotional difficulties holistically (Geddes and Hanko, 2006; Gross, 1987). Consequently, staff's understanding of the impact early experiences can have on the children's behaviour at school could contribute to the emotional heath and well-being of all pupils (Geddes, 2006). Dowling and Osborne (1985; cited in Geddes, 2006) stress that children develop an understanding of relationships based on their experiences with parents and siblings, friends and extended family. Through these primary experiences, Dowling et al. explain how children will develop an understanding of rivalry for parental affection, sharing and ownership. Stern (1985) maintains that experiences of being in the company of an other are to be seen as active acts of integration, rather than as passive and unsuccessful intends of differentiation of their self. Both siblings seem to have recently suffered deterioration in their emotional well-being, yet they appear to be expressing these difficulties in very different ways: while EE is approaching adults for comfort, JE is 'attacking' them. These differences, explains Bee (1997), could find an explanation in the biological argument explaining temperament and personality. The biological perspective considers that each individual is born with characteristic patterns determined genetically, which then establish the individual's responses to the environment and to other people (Ayers, Clarke and Murray, 1999; Bee, 1997). Goleman (1996) supports this statement and adds that each individual inherits a series of pre-set emotional features, which determine his/her temperament. It would seem, however, as if by adopting a biological perspective to explain the differences in the siblings' behaviours, the birth order of the children would then not be accounted for, nor any environmental factors. This would then contradict the advice of a number of researchers who advocate for the need to adopt an eclectic approach to the analysis of SEBD (Cooper et al., 1994; Cooper, 1999; Jones, 1999; Visser, 2002; Visser, 2005). JE is the second of three siblings and the family is currently expecting a fourth baby. EE was diagnosed with ASD soon after JE was born. Stern's (1998) assumption that experiencing the self in the company of another is to be seen as an experience towards integration might not have been such for JE. Links between Attachment Disorders and Mental Health Problems can be found in Greenhalgh's (1994) work when he refers to Klein's (1946) concept of the paranoid-schizoid position, which is characterised by the individual's strong need for omnipotence, or in another words, the need to have things one's own way. They relate omnipotence to the fear that allowing others to get their ways will stop the individual from preserving the experience of things being good. When identifying the problem behaviours in previous sections of this essay, it was mentioned JE's need to dictate his own way (e.g. he is to go to the toilet any time he wants to, not when he is scheduled to; he finds it very difficult to cope with the adult's authority, often challenging it and reacting violently when feeling contradicted). Geddes (2006) applies the principles of the attachment patterns originally determined by Ainsworth et al. (1978; cited in Geddes, 2006; Rutgers et al. 2007; and Pearce, 2009) to the classroom's teaching and learning dynamics. She does so with what she names "The Learning Triangle", established between the child, the teacher and the task. Rutgers et al. (2007) reached the conclusion that children with ASD tend to be less secure and more disorganised in their attachment pattern. This assertion could provide a theoretical basis to critically consider JE's SEBD difficulties as being caused by a disorganised /disorientated attachment. When describing pupils whose attachment pattern is of this type, Geddes (2006) identifies the following responses to their schooling and learning:
"â€¦ the pupil is likely to: appear in a heightened state of anxiety; be highly vigilant and notice any slight distraction; have an absence of trust in the authority of adults; be insensitive to others' feelings; place considerable importance on objects rather than relationships; may bully others perceived as vulnerable/reminders of their vulnerability; get into trouble a lot in relatively unsupervised settings such as the playground; experience overwhelming affect (feeling) which has no apparent meaning; sudden react to unseen triggers; be extremely sensitive to criticism and implied humiliation; have little development of the capacity to reflect â€¦ and sadly appear to enjoy very little."
(Geddes, 2006; pp. 108)
JE's problem behaviours seem to be consistent with most of the patterns described above. When JE joins a lesson in the RB, he is asked about his mood. All pupils in his group are invited to register themselves according to six basic emotions. JE has only managed to identify two of the choices, excitement and anger. Over the past month, JE has regularly indicated feeling angry but he cannot express the reason behind his emotion. Research on the origins of anger and rage link aggression and violence to weak bonding in infancy and weak parenting (APA Commission on Violence, 1993; cited in Geddes, 2006). Geddes (2006) also quotes Holmes' (2001) definition of outbursts of rage as a form of 'displacement activity' resulting of an individual's dilemma between fear and need. She also classifies the learning profile of disorganised students as that of being omnipotent and controlling when approaching the classroom, reaching to the same consideration as other authors previously refer to (e.g. Klein, 1946 in Stern, 1998).
On the other hand, EE is responding well to a nurturing approach to his emotional needs, which Clements (2005) identifies as one successful strategy for those individuals with ASD who like EE are sensitive or anxious and ready to avoid situations. When considering Geddes' "Learning Triangle" to critically analyse EE's SEBD, the evidence compiled with the SALT; the fact that he is approaching the adults in the RB when feeling upset and/or distress; his growing ability to work independently with the support of visual aids; and his good response to the nurturing approach staff is adopting, could contribute sufficient evidence to consider EE as a securely attached pupil who over the last two months has been experiencing some external strain. His condition of first-born and his kind and gentle manner would appear to have contributed to his development of a secure attachment with his mother. Over the years, he has demonstrated a capacity to adapt to school and to respond to the demands of the academic and social setting in which learning takes place, which Geddes (2006) identifies as features characteristic of secure attachment, a social and emotional skill that children with ASD are capable of achieving (Rutgers et al. 2007). Geddes goes to describe the secure attached pupil as a child who presents with high scores of ego-resilience and self-esteem, less dependency on the teacher with the past of time, but with a growing affect for him/her. The securely attached pupil can increase the intentionality in his/her interactions with others and s/he is generally more co-operative. This would seem consistent with the recent improvement in EE's expressive skills assessed by the SALT as well as his ability to allow a key adult to help him focus back on task after an incident that may have upset him.
Conclusions and advice for further practice
It would seem that EE's emotional distress needs to be further assessed within the work of a multi-disciplinary team in order to bring some light to his family situation. His anxiety could be rooted to home events that are yet to be clarified. From an educational point of view, staff needs to advocate for his emotional well-being and continue offering a nurturing approach to his current needs (Clements, 2005).
The conclusion reached in this discussion regarding the possible implications of an identified attachment disorder for JE, along with the nature of his behaviours, imply that the educational priority for the immediate future is to provide JE with safety, reliability and predictability (Geddes, 2006). Visual cues, such as visual timetables, are already being used. Clear expectations and behavioural boundaries are common and consistent practice amongst the staff of the RB and, in few occasions, JE has shown some positive responses to the authority of one of the teachers. It appears necessary that these same boundaries are consistently used in the mainstream provision. In order to guarantee that, the teacher with whom he seems to be developing a positive relationship could be allocated as his key worker for a period of time. For children identified as having a disorganised/disoriented attachment pattern, Geddes (2006) also recommends the use of a 'physical container' as a possible therapeutic strategy. She advocates that this resource can be interpreted as a 'secure base'. This approach needs to be further explored, but taking into account that JE is very fond of comic characters, providing him with a toy that he can place in and out of a box during the school day as required by his emotions could facilitate him with a tool with which to explore and regain interest in the world around him. JE shows interest in playing with his peers and it is often his lack of skills to initiate positive interactions at playtimes that causes him trouble. JE could benefit from adult support at playtimes to facilitate good role models and assertive approaches to conflict, social skills strategies recognised as useful in helping individuals to improve their self-concept and achieve optimal levels of self-esteem (Roffey, Tarrant and Majors, 1994).
EE and JE have both been displaying abnormal behaviour patterns and despite very similar diagnoses of ASD, they have been exhibiting markedly different responses to what is assumed as external factors possibly stressed within the home. Through this examination of attachment and associated disorders, it has been hypothesized that the variation in the boys' response could possibly be due to JE suffering from an attachment disorder in addition to his original diagnoses of ASD. For this supposition to be validated it is acknowledged that there is need for an extensive multidisciplinary investigation in the home dynamics and further analysis of JE's mental health.
The value of investigating attachment and associated disorders when analysing possible causes of individuals' SEBD is that it can inform staff to look further than the original ASD diagnoses. If the supposition of JE presenting with an attachment disorder of a disorganized/disorientated pattern is correct, working on developing JE's attachment to and trust of staff, as well as maintaining the specialised ASD provision within the RB, can only be of benefit to him. Unlike EE, JE is not responding to the strategies advised as best practice for children with ASD.