THE SOCIAL COGNITIVE THEORY AND TREATMENT OF ASPERGER SYNDROME/ AUTISM
Marcelo Bolshaw Gomes[1]
Abstract: This text, besides intending to be a short commented summary on the progress and limitations of the ideas of the contemporary psychologist Albert Bandura and the main concepts of the social learning theory and social cognitive theory, also deals with the evolution of theories and treatments on autism. The idea is to demonstrate that the new cognitive psychologies can help to understand and treat (together with other therapies) the development disorders of the autistic spectrum, specially the Asperger syndrome.
Keywords: cognitive psychology – Asperger syndrome – social learning.
Introduction
During the 1990s, the ideas of Bandura began to play an important role in the global scenario, starting to be taught in almost every Psychology and Pedagogy Universities in the world. More than this: millions of people, disappointed with psychoanalysis and Behaviorism, started to work therapeutically based on the cognitive behavioral approach proposed by Bandura and other researchers. There was a switch from the therapeutic model of interpretative interviews to the oriented training towards action.
For Bandura the starting point is to ask how people exercise control over their behavior. For the followers of the one-way environmental determinism (or Behaviorism) men is a product of the environment. On the other hand, to the different types of idealistic humanism it is men who create the conditions in which he develops. Both perspectives, although antagonistic, believe in the reciprocity of opposite aspect. In other words, the behaviorists believe in human capacity of changing the environment, as much as the Idealists observe the environmental conditioning.
Bandura´s model is the result of three simultaneous theoretical interfaces: his criticism of Skinner´s radical behaviorism, his dialogue with other cognitivists as Piaget and his clinical and therapeutic progress in relation to psychoanalysis and Freud. In relation to Skinner, Bandura introduced the category of Self (not in the esoteric way as in Jung´s tradition, but as a field of subjectivity and affective interpretation of the stimuli). In contrast, Bandura puts Freudian reflection within a behavioral context. And finally, in relation to Piaget, Bandura rethinks the idea cognitive learning.
Only the social learning theory brings a third term in the model, assuming a reciprocal determinism between personal, behavioral and environmental factors. In the Social Learning Theory, there is a control system – the agency and its cognitive functions – in which the self-regulation is governed by anticipating and by affective self-reactions.
Our first enunciation is that the triadic model of reciprocal conditioning prepared by Bandura allows defining autistic behaviors as those that have no direct interaction between behavior and environment, causing the development of resilience, echolalia, recurrences and fixations in the cognitive field. The autists learn to adapt their behavior indirectly through secondary modeling or repetition of the primary modeling of behavior.
The autistic behaviors are characterized by three basic factors: lack of sociability, communication difficulties, obsessive and repetitive imagination. In autism, there is an error in the reciprocal social interaction: often the autistic isolate himself as if he were in another world; is passive before others and have hard time being with more than one person at the same time; his attempts of social interaction may be disastrous and inapt. Also there are communication difficulties. Some do not speak and have little non-verbal language. Others have limited speaking, with imitation which may be of what the interlocutor had just said (immediate echolalia) or from more distant situations (remote echolalia).
It is common the use of the third person instead of ‘I’, the abbreviation of sentences, expression of the strictly necessary, ignoring social contact and ‘chatting’. The language presents alteration in the reciprocal discourse, in the comprehension of symbolic language and strange intonation, despite the intact vocabulary and grammar. And, finally, there is limited imagination; continuous repetition of movements, routines or specific activities; drastic behavior reactions before changes as, for example, replacing an object in the house; personal rituals; perfection mania; everything must be symmetrical and cannot be out of place. Like to align things, put objects in and out of a box. They have little spontaneity; demonstrate body mimesis, with stereotypical behavior, badly copied from others.
Our hypothesis is that two of these three features (communication difficulty and the absence of sociability) are caused by low behavior-environment interaction, while the third characteristic, the dysfunction in imagination and language, is a form of cognitive compensation, which may develop as resiliency, as in the case of the Aspergic. This, however, does not mean that the ontogenetic and phylogenetic conditioning factors overlap subjectivity and the Self. On the contrary, in the model of Bandura and (so we believe) in the autism symptomatology, conscience is the determinant factor. However, it is also the most variable and flexible factor, adapting to the different types of conditionings.
Autism and Asperger syndrome
Autism was scientifically described first in 1943, by the Austrian doctor Leo Kanner. One may subdivide the development of the studies over the autistic syndrome[2] into three distinct steps: psychogenic phase (or psychoanalytic), in which Autism was understood as an acquired emotional disorder. The behaviorist phase (and vygostskyan), since the 1970s, in which the autism will be seen as an organic-behavioral disorder of biological and hereditary nature (time of the ‘discovery’ of the autistic spectrum[3]). And the current phase, neuro-scientific and cognitivist, in which the genetic, cognitive and environmental factors influence a different brain anatomy. The initial mark of this phase is the clinical research developed by Donald Winnicott over the decisive role of subjectivity in autism.
One can also say that the Asperger Syndrome (AS) is a less serious disorder of the autistic continuum[4]. AS is a disorder of multiple functions of the psyches, mainly affecting the area of interpersonal relationship and communication, while the speech is relatively normal. There are still specific skills and interests, pedantism, stereotyped and repetitive behavior and motor disorders. The aspergic are visual thinkers, literal and inflexible. Oriented by routine and rules, they have a hard time socializing, are quite reliable people and obsessed with their favorite subjects, matters and interests.
At this third stage of research, several partial scientific explanations for the causes of autism have been drawn up, giving emphasis to different aspects: cognitive theories (deficit of executive function, deficit of central coherence, and deficit of Meta-representation), which admit the environmental and innate factors, highlight the role of subjectivity; the hypothesis of food poisoning, which accepts the role of Self and genetics, emphasizing the environment; and the explanations that give priority to the anatomical differences of the brain determined by genetic heredity.
The cognitive theory for the deficit in the executive function is based on the evidence of a compromise on the ability of planning and execution in autism and the similarity between the behavior of individuals with prefrontal cortical dysfunction and those with autism: inflexibility, perseverance, primacy of detail and difficulty of inhibiting responses.
On its turn, the cognitive theory of the deficit of central coherence in representation is an improvement of the executive dysfunction theory which emphasizes the difficulty of processing concepts of abstract totalities and a preference for processing images from concrete partial realities. The cognitive theories have a common characteristic: to assign the social deficits in autism to difficulties in modulate both sensory data and perceptive experience. This way, the autistic ‘retraction’ has been explained in terms of a chronic state of excitement or fluctuations in those states which lead to avoid glances, negative reactions and retraction of social interaction, as mechanisms to control excessive stimulation.
Recovering the notion of innate deficit on the ability to get into affective harmony in autism, identified by the psychoanalytic approaches, also explanation of damage in the ability of meta-represent emerged (or more specifically, the inability to develop a mind with ‘another inside oneself’), as an explanation factor for the autistic spectrum syndromes.
The second major contemporary hypothesis, of food contamination, believes that autism is caused by oxidative stress, inappropriate methylation and sulphatation disorders that reach the brain, provoking what we call autism.
Dr. Amy Yasko is holistic physician and naturopath, works in the USA with a protocol that is done through genetic examinations, based on the genome project and more precisely with epigenetics, science that aim to clarify how environmental factors (dietary habits and stress, for example) may interfere with the functioning of genes. In this perspective, the autistic behavior remains in a tripod that involves the immunologic, intestinal, and endocrinal systems. And the main causes for the autistic disorder are: (a) the presence mercury and heavy metals accumulated in the body; and b) the production of morphines by the body, metabolized from gluten and casein[5]. The protocol is based upon treating autism through the metabolic process of each individual, especially the gluten and casein free diets, vitamin B6 supplements, and use hyperbaric chamber. This hypothesis is embraced by important as organizations such as the Autism Research Institute[6], responsible for the DAN (Defeat Autism Now). Here in Brazil, DAN is represented by ADEFA (Associação Em Defesa do Autismo) and the movement started to be called “autism is treatable”[7]. According to the DAN Protocol there are many issues to be analyzed[8]. Each case has a combination. One may localize the imbalances of the body through specific examinations of blood, urine, feces and mineralogram; and it is prescribed a specific nutritional and biochemical therapy for each case, together with an intensive educational treatment.
And, finally, there are still the approaches that privilege the genetic aspect, considering subjectivity and environment secondary. In April 2008, American College of Medical Genetics (ACMG) established clinical practice procedures to be followed by Clinical geneticists, both to determine the etiology of the cases of disorders from the autistic spectrum and to treat patients with this diagnosis. This study confirms that currently there is a well-established routine, clinically available, with biomarkers that help clinical geneticist to evaluate and treat the individuals, briefly describing some biomarkers identified, important clinical tools identified for medical assessment and response to the monitored treatment[9].
Among the approaches that emphasize the brain anatomical differences, we may highlight Ramachandran, V.S. and L.M. Oberman´s, “Broken Mirrors. A Theory of Autism”, that affirms that the anatomic deficiency on the system of mirror neurons is the cause of autism. The mirrors neurons are responsible for shaping the behavior from the environment and its biological dysfunction would explain the cognitive overload, once the mimesis function would be developed by other parts of brain. Also in this paradigm, there are many such as Oliver Sacks (1995) that no longer consider autism to be a disease but rather a different way to feel and think the world, as valid as any other. Although having a different brain anatomy is not necessarily pathology, for the majority of people, autism is still a serious problem in life and not ‘an alternative way of being’[10].
While naturalist doctors give excessive emphasis on the gluten and casein free diet and radical detoxification of heavy metals; psychiatrists believe the prevalence of genetics/ anatomic difference of the autistic brain; and clinicians, to the hypothesis of cognitive mismatch; each one betting on specific genetic, pharmacologic, or psycho pedagogic therapies. However, the best treatment results are achieved adopting various therapies together – what comes from the conception that believes in a system of multiple determinants and not in one single main cause for the autistic spectrum disorders.
And this leads to our second enunciation: the Social Cognitive Theory, due to its model of reciprocal conditioning between environmental, cognitive and heritable factors, is the ideal philosophy for the integration of treatments and therapies on Autism, through the technique of modeling.
Modeling
The most important theoretical and practical contribution of Bandura is the idea of modeling. Modeling means the adaptation/change by creative mimesis of behaviors, that is, through the reinterpreted imitation of attitudes, gestures, ideas, affections. For him, every social learning is given through modeling of behavior.
The term ‘mimesis’ was used by Plato and Aristotle (and many art researchers and philosophers such as Paul Ricoeur) to designate the same as ‘modeling’: creative apprehension (many times unintended) of others procedures for incorporation into one´s own behavior.
In his early works (1961-1986) concerning social learning theory, Bandura studied the pedagogical role of imitation. In a second moment (1986 until now), he will deepen his studies in order to verify the therapeutic efficacy of imitation, of “transmission of procedures through modeling”, especially in the treatment of psychological phobias and dependencies. However, it is important to cite the famous experience of modeling aggressive behavior with Bopper Bop Buddy[11] In the experience a group of children watched a film with adults (of both genders) shouted and assaulted an inflatable doll. The children were separated and a group of control was not submitted to the movie presentation. In the time that ‘Bop Buddy’ is introduced to the child, they have no hostile attitudes towards the doll. However, after observing the adult having an aggressive behavior with the toy, the children start reproducing the aggressive behavior. Bandura observed that the children who had seen the movie presented the twice aggressive responses compared with the group of control, including inventing new forms of aggression that not had been observed. He also noticed that among those who were exposed to violence, boys were more vulnerable to the aggressive imitation than girls.
Modeling as therapy was originally used by Bandura to work with people with obsessive fear of snakes, making them imitate models of snake exposure, thus overcoming the phobia. Bandura realized that modeling provides both in social learning and in therapeutic re-adaptation, three different effects of change in behavior: the Modeler, interpreter and the observer[12].
It is commonplace to say that autistics, mainly people with AS, copy behaviors, speeches, accents and appearance of others. On the other side, one of the most common symptoms on autism diagnosis is the inability to put oneself in the place of others or even the ability to represent and/or abstract. It may seem contradictory, but the two affirmatives are true: Aspergic are remarkable imitators at the same time that are unable to represent. If our central hypothesis is correct, autistics have difficulty in modeling involuntarily, they need to learn to learn behaviors. The three distinct Bandura effects are simultaneous, but can also be seen as the development steps of the modeling technique for autistic syndromes and the integrated objective of his cognitive training must be the development and expansion of the capacity of meta-representation. Training through modeling incorporates other psycho-dramatic and theatrical techniques.
But let´s get to the point: our second enunciation is that the modeling elaborated by BANDURA is the ideal method for integrating the Autistic disorders treatments.
The ABA (Applied Behavior Analysis) treatment is the main program of intensive instruction of skills necessary to ensure that the individual diagnosed with autism or development invasive disorders may acquire the best life quality possible. Learning opportunities are repeated many times, until the child show the ability without mistake in various environments and situations. The main feature of the treatment is the use of positive or strengthening consequences (gifts, compliments, rewards).
Bandura´s Modeling works with three types of positive reinforcements: past incentive (traditional or classic Behaviorism), promised reinforcement and vicarious or indirect reinforcement, the selective capacity of self-motivation through the choice of the environment, models and reinforcements. Note that these reasons have traditionally seen as the ‘causes’ of learning. Bandura says that they are not determining ‘what’ we learn, but conditioning ‘how’ we learn.
Of course, there are also three negative motivations to imitate: the remembering of punishments, threatening (promised punishment) and vicarious punishment through situations that require great performance or frustrate the apprentice inhibiting undesirable behaviors. Bandura says that the punishment in its various forms, does not work as well as the positive reinforcement and that, in fact, there is a tendency on the restrictions system to go against the development of the learner. By ‘punishment’ one should not understand beating or moral coercion, but consensual penalties assumed in advance, ‘gifts’, compensatory activities conducted spontaneously. The positive use of guilt allied with changes in the forms and occasions for self gratification may accelerate a learning process through modeling. In any case, Bandura´s modeling allows bringing great increment to the ABA treatment on its traditional conception.
In the movie Son-rise: a miracle of love, 1979[13], There is a scene where behaviorist doctors criticize the parents of the protagonist autistic boy because they are imitating his pathological behavior, while ‘the correct’ would be that only the child imitate his parents and teachers. And, as movie shows, the key to get into emotional contact with the autistic child is precisely the modeling reciprocity; the fact of it being two-way is what creates real communication. The great relevance of this approach however, is to prove the central role of affectivity in changing the autistic behavior. And, in the ABA, imitation is unilateral and follows a one-one model of interaction.
Another form of autistic treatment through cognitive training very well known and applied is the TEACCH[14].While ABA is a behavioral therapy that aims to adapt the carrier of the disorder to the social environment, the program TEACCH, more actual, brings an emphasis on the development of the neuro-cognitive difference awareness. Change the behavior is not a goal in itself. It is possible to combine strategies of TEACCH and ABA, however, it is very important for them to be philosophically integrated (By the Cognitive Social Theory, for example). Perhaps those who work with ABA do not emphasize so much the autonomy, sometimes being difficult to avoid that children become dependent on models. On the other side, working with the TEACCH approach may lead to focus too much on independence and cease to work with imitation.
Among the many therapies, there are also combination possibilities, but the most important are: occupational therapy, sensory integration therapy and speech therapy. The integration of therapies can be based in TEACCH and ABA programs. It could also use PECS (Picturing Exchanging Communication System) resources.
I had already acknowledged the educational and therapeutic potential of imitation, due to my experiences with the Repetition Circle. BANDURA, however, makes an impeccable scientific reasoning construction with several empirical researches and many specific discussions.
The Repetition Circle is a technique that consists in imitating together each participant of the circle. The order and the time of participation can be free, in an organic manner; or it may be established a sequence (clockwise, for example) and a specific time (minimum and/or maximum) for each one, but the imitation must be as perfect as possible in terms of movement, voice and intention – highly avoiding to ‘interpret’ the other, although this is inevitable and people end up seeing how they are seen by others. This is not the main function of the exercise, just an initial stage. Over time (about 30 minutes), an unconscious connection among participants is created, and they start to feel their presence in others and the others presence within themselves, and a deep game of exchanging identities and ways of seeing and thinking is established. The Circle involves different applications such as pedagogic (language and music teaching, mythical storytelling), therapeutic (expression of suppressed emotional content, expansion of the individual identity) and hypnotic (imagination travelling – repetition of voices with the eyes shut), although the true essence of this practice is its playful and open to improvisation character. The repetition circle opens the door to countless other circle techniques (Biodanza, circular dances, ring around the rosey), psychodramas, dreams and mythical narratives.
However, in order to promote such integration of treatments and therapies through social learning by modeling of behavior, it is not enough to adopt imitation as primary technique, it is also necessary to highlight the relevant processes of cognitive mimesis:
1. Attention. If you will learn something, you need to be paying attention. Attention is the focus of perception. Some of the factors that influence the attention have to do with the model properties. If the model is colorful and dramatic, for example, have more attention. If the model is attractive, prestigious or appears to be particularly competent it will draw more attention. And if the model is closer to us, it calls further attention. These variables were used by Bandura to measure the effects of television over children.
2. Retention. Secondly, we must be able to remember what we were paying attention to. Here, imagination and language are included, reanimating the image or description so that we may reproduce it with our own behavior.
3. Reproduction. At this point, we are daydreaming. I can spend a whole day watching an Olympic ice-skater and not be able to reproduce his jumps, because I know nothing about skating. It is necessary to have the ability to reproduce the behavior memorized. On the other hand, it is through imitation that one improves its own behavior.
4. Motivation. In addition to pay attention, remember the behavior and knowing how to reproduce them, we still would not modify ourselves unless we have a good reason to do so. As we saw, there are three positive and three negative reinforcements.
“To learn to learn” through observation and modeling of behaviors, implies the ability self-regulation and the learning subject ‘to be an agent’, that is “to make things happen intentionally” (2008, 69) depending on the development, adaptation and change – not only behavior but also on the environment that conditions and determines it.
The idea of Agency
The idea of Agency, more than being defined as mere mediator of environmental and behavioral aspects, has a key role in the constitution of these factors and is formed from four distinct cognitive activities: intentionality, anticipation, self-reactivity and self-reflection.
1) Intentionality – In addition to the conscientious desire of change and/or adaptation of behavior, the intention to modify over time implies plans and strategies.
2) – Anticipation – Furthermore, the planning to modify one´s own behavior implies determining goals and foreseeing results.
3) Self-reactivity or self-regulation as a cognitive activity necessary to change of behavior can be subdivided into: a) motivation, this is, the ability to maintain emotionally confident about change, mainly trough beliefs of self-efficacy; and b) actual self-regulation, which for BANDURA is given mainly through modeling (the creative imitation of other models of behavior).
4) Self-reflection – It is consciousness, understood as self-reference and metacognitive ability to reflect about yourself as the main inward factor in social learning process and in adaptive behavior changes.
Agency can still be personal, delegated or collective; but never individual in order to avoid dichotomy with social. In particular, I also do not like collective agency. What is important, however, is that the notion of agency allows to think about the possibilities of increasing the autonomy of the behaviors according to its conditioning, then changing part of this conditioning.
An example: in order to change a diet (to cut sugar and carbohydrates with gluten – which is fundamental to the autistics), a person should, first, understand that the desire is stronger than the will, desiring to have quality of life (or “to stay fit and good-looking”) to win the will to eat candies and pasta, and not the opposite (place the will against the desire to eat it).
But the correct definition of the desire to be intended, avoiding interpreting the restriction as corporal punishment, is not enough without a strategy and a plan involving time, reinforcements, conditioning changes. The faculty of anticipation, on its turn, allows constant redefinition of possible goals and the motivation through the results achieved. The person may, for instance, avoid for some time situations and places that lead to a dietary derange. Self-regulation presents two aspects. Belief that one is able to change habits is preponderant to do so. Many self-help books advise to use the gerund (“I am changing”) or even long-term decision artifice (“I already decided to lose weight and I will no matter how many times I need to start again”). The other aspect is modeling, that is, the imitation of healthy people behaviors: the example of friends who are admired and family support, besides different therapeutic reinforcements, exercising, and other routines. The body learned to eat junk food by modeling and need to learn other behaviors in order to quit the old conditioning.
Self reflection, as sub-function of cognitive agency is the understanding of the excessive consumption of sugar and starch (actually, a dopamine addiction associated to alimentation) as a good opportunity for the mind un-conditioning. Conscience is grateful for the lessons of compulsion; therefore understands its role in the development. Even considering the self-reflection as the most important sub-function in the process of cognitive agency between behavior and environment, Bandura emphasizes self-regulation.
Process of self-regulation (trough contingency self-prescribed)
The process of self-regulation, to BANDURA, begins with self-observation, followed by self-judgment, which enables self-reaction. The cycle of the self-regulation sub-functions is not automatic and the steps only occur when activated selectively and voluntarily by conscience. Bandura prescribes a mental self-observation of medium and long term, based on two groups of parameters: performance dimensions (addiction motivations) and quality of monitoring (how many times and how we observe ourselves). These two parameters allow establishing self-judgment procedures, taking into account our personal standards as well as other performance references (comparisons with others and with one own performance at different times).
Then it may be established the value of the activity observed and whether their determinants are external and/or psychological. From then on, emotional self-reactions of enthusiasm and frustration are evaluated and the punishment and incentives measures required to modify the observed behavior are prescribed. At this point, we realize the importance of the subject's observed/observer system of beliefs. And among the beliefs, Bandura highlight the importance of the belief in one own efficacy as being the most relevant in social learning.
The belief in self-efficacy
To Bandura, among the factors that provide a dynamic self-regulation towards the change in habits and behavior is the belief in self-efficacy, resulting from the expectations of performance and the outcome.
Said like this it may seem ‘positive thinking’ or another self-help illusion, in which by desiring one thing, it happens - as in the movie The secret. However, the self-efficacy is only the judgment of the personal capacity (2008,32) and not a magic or telepathic force capable of influencing events.
While the self-image (or self concept) is a resultant of the past and the self-esteem is rooted in the present emotional situation, self-efficacy is a belief that refers to the future. “Self-efficacy is the judgment of the capacity to organize and perform actions necessary to achieve certain types of performance” (2008,101).
Then, let´s see how the belief in self-efficacy fits into the set Bandura´s ideas. A conscious intensification of this secondary modeling, through the training of social skills is highly recommended in numerous situations, for example when the person is submissive socially and intolerant with the family. Usually this behavior (as well as other alike) is the result of an inappropriate education of people with severe special needs and it can be modified through one-to-one modeling.
However, to people with Asperger syndrome (as well as for other types of high functioning cognitive disabilities in which the carriers have autonomy), the cognitive social theory prescribes self therapy, in which the belief in self-efficacy has a central role. A technique that have been successfully applied to problems such as smoking, eating disorders, chemical dependency and change of habits in general.
It may be subdivided into three procedures:
1. Behavior record. Self-observation requires you to write forms of behavior, both before and after the attempt to change. This includes simple things like counting the food consumption per day until more complex behaviors, such as, for example, every reason for eating them.
2. Environmental planning. Change the environment: eliminate or prevent situations that lead to addiction (television, refrigerator, children). Also to change environment: doing gymnastics, enjoying nature, avoiding bars or programs associated with reckless alimentation.
3. Self-Contracts. Least, there is a declaration of commitment to the change plan, with its rewards and punishments. These contracts must be written in front of witnesses (our therapist, for example) and the details must be very well specified: "I'm going out to dinner on Saturday only if I don't eat junk food this week. Otherwise, I'll stay at home working.” Or similar promises.
In one-to-one, modeling therapies, others (the therapist and parents) control the rewards and punishments to motivate the change in behavior, because people with severe needs are not able to be very strict with themselves. In the self-therapy, however, it is a matter of strengthening even more the agent´s ability of self-regulation, giving the maximum supervised autonomy to ensure a minimum of frustrations and negative experiences. Of course error is part of learning. However, in the development of the belief in self-efficacy is more important to celebrate victories than to reassess unsuccessful attitudes.
Another important policy is to establish the self-efficacy and cognitive disabilities domains and establish targets for difficulties reduction and optimization of capabilities. Following the same example: an autistic believes his efficacy in the mathematical or musical domains and his disability in the field affective and social life.
One could say that the set of domains (efficient and deficient) form a vicious circle of co-recurrent causes in which recurrent situations repeat compulsively and unintentionally. The vicious circle can be reversed through a plan of life excellence, removing and adding reinforcement factors, in order to maximize the self-efficacy domains and minimize the disability domains. And as that the person realizes these repetition patterns, the vicious circle breaks and there is a cognitive reorganization and a progressive change in its internal structure.
In most cases, we should think of a gradual process that begins with the condition of a dependent patient (of the family and the therapist reinforcement) and evolves into the context of an aware agent that struggles to achieve autonomy, transforming as he transforms his environment. Typically, this requires that mothers (and sometimes, fathers and brothers) also get into therapeutic process, training new behaviors.
There are several ways to define the efficiencies and deficiencies, as well as to understand domains and detail them. On the website ‘Coaching Asperger’ there is a list of the eight competitive advantages of Asperger[15]- which is quite interesting, but limited to the professional domain.
From the point of view of schooling (and cognitive development of language and communication), there is actually a strong emphasis on computer usage as prosthesis of the autistic mind[16] and in the fact that there is a great number of people with AS that become programmers ‘naturally’. But when we talk about mental prosthesis is not only a matter of the visual cognition offered by computer syntax, but a matter of the constitution of an identity ‘at distance’ through the Internet, transforming introverted and isolated individuals in a network of social beings, which is a prerequisite not only for an effective social action in a voice in the public arena but, above all, to a change in the autistic behavior and identity[17].The most important of these first groups is the ANI (Autism Network International)[18].
Of course, computers do not replace the dedication of teachers, nor the parental affection and attention. It is only a tool to overcome the triple disability of autism (communication, social interaction and recurrent behavior), an instrument for self-efficacy development. The important thing is the change in attitude.
It is, primarily, through self-representation, that the autistic can develop their autonomy and win the scheme of physical and psychological dependency inherent to their condition.
Conclusion
In addition to perform a brief commented summary of ideas of the contemporary psychologist Albert Bandura, his main concepts were applied here to the treatment of high functioning autism and/or Asperger syndrome.
With the triadic model the autistic behaviors were defined as those who have a disability on direct interaction between behaviors (ontogenetic conditioning), environment (phylogenetic conditioning) and the Self, in which resiliencies, echolalia, recurrences and fixations in the cognitive field develop. We stress also that, in Bandura´s perspective, behavior and the environment are conditioning factors, while the Self, the subjectivity, and the consciousness are determinant factors for cognitive development and social learning.
Then, with the method of social learning through four processes modeling (attention, retention, reproduction and motivation) as the ideal method for the integration of treatments and recovery therapies for people with Autistic disorders: casein and gluten free diet (compiled from clinical examinations), medication (according to the genetic biomarkers) and psycho-pedagogic training of the cognitive representation capacity[19].
With the notion of Agency and its cognitive properties (intentionality, anticipation, self-reactivity and self-reflexivity) considerations of self-regulation (anchored in observation, judgment and self-reaction) from the Social Cognitive Theory were presented.
Finally, we presented the belief in self-efficacy, discussed the techniques of self-therapy (behavior records, environmental planning and use of self-contracts) treating AS treatment, mainly with the use of computers and Internet.
And ended up concluding that: it is through self-representation in its different spheres (social, political and personal) that the autistic can conquer autonomy and a better life within society.
BIBLIOGRAPHY
BANDURA, Albert. Teoria social cognitiva: conceitos básicos. Porto Alegre: Artmed, 2008.
BOSA, Cleonice. Autismo: breve revisão de diferentes abordagens. Revista de Psicologia: Reflexão e Crítica (ISSN 0102-7972) vol.13 n.1 Porto Alegre, 2000.
GODOY, Herminia Prado Síndrome de Asperger: Revisão Bibliográfica. Trabalho de Conclusão de Curso. PUC-SP, 2008.
GOMES, M. B. Um Mapa, uma Bússola - Hipertexto, Complexidade e Eneagrama. Rio de Janeiro: Ed. Mileto, 2001.
SACKS, Oliver. Um Antropólogo em Marte / Sete Histórias Paradoxais. São Paulo: Editora Companhia das Letras, 1995.
RAMACHANDRAN, Vilayanur & OBERMAN, Lindsay. Espelhos Quebrados – uma teoria sobre o autismo. Revista Scientific American Brasil, ANO 5 – Nº 55 12/2006. http://www.sciam.com.br/
RIBEIRO, Valéria Llacer Bastos. Breve análise da cognição da pessoa com autismo e porque o computador tem um papel preponderante na educação da pessoa com autismo. http://euautista.blogspot.com/2009/06/cognicao-visual.html
RICOEUR, Paul. Tempo e Narrativa. Tradução: Constança M. Cesar. 3 volumes. Campinas: Papirus, 1994.
Marcelo Bolshaw Gomes[1]
Abstract: This text, besides intending to be a short commented summary on the progress and limitations of the ideas of the contemporary psychologist Albert Bandura and the main concepts of the social learning theory and social cognitive theory, also deals with the evolution of theories and treatments on autism. The idea is to demonstrate that the new cognitive psychologies can help to understand and treat (together with other therapies) the development disorders of the autistic spectrum, specially the Asperger syndrome.
Keywords: cognitive psychology – Asperger syndrome – social learning.
Introduction
During the 1990s, the ideas of Bandura began to play an important role in the global scenario, starting to be taught in almost every Psychology and Pedagogy Universities in the world. More than this: millions of people, disappointed with psychoanalysis and Behaviorism, started to work therapeutically based on the cognitive behavioral approach proposed by Bandura and other researchers. There was a switch from the therapeutic model of interpretative interviews to the oriented training towards action.
For Bandura the starting point is to ask how people exercise control over their behavior. For the followers of the one-way environmental determinism (or Behaviorism) men is a product of the environment. On the other hand, to the different types of idealistic humanism it is men who create the conditions in which he develops. Both perspectives, although antagonistic, believe in the reciprocity of opposite aspect. In other words, the behaviorists believe in human capacity of changing the environment, as much as the Idealists observe the environmental conditioning.
Bandura´s model is the result of three simultaneous theoretical interfaces: his criticism of Skinner´s radical behaviorism, his dialogue with other cognitivists as Piaget and his clinical and therapeutic progress in relation to psychoanalysis and Freud. In relation to Skinner, Bandura introduced the category of Self (not in the esoteric way as in Jung´s tradition, but as a field of subjectivity and affective interpretation of the stimuli). In contrast, Bandura puts Freudian reflection within a behavioral context. And finally, in relation to Piaget, Bandura rethinks the idea cognitive learning.
Only the social learning theory brings a third term in the model, assuming a reciprocal determinism between personal, behavioral and environmental factors. In the Social Learning Theory, there is a control system – the agency and its cognitive functions – in which the self-regulation is governed by anticipating and by affective self-reactions.
Our first enunciation is that the triadic model of reciprocal conditioning prepared by Bandura allows defining autistic behaviors as those that have no direct interaction between behavior and environment, causing the development of resilience, echolalia, recurrences and fixations in the cognitive field. The autists learn to adapt their behavior indirectly through secondary modeling or repetition of the primary modeling of behavior.
The autistic behaviors are characterized by three basic factors: lack of sociability, communication difficulties, obsessive and repetitive imagination. In autism, there is an error in the reciprocal social interaction: often the autistic isolate himself as if he were in another world; is passive before others and have hard time being with more than one person at the same time; his attempts of social interaction may be disastrous and inapt. Also there are communication difficulties. Some do not speak and have little non-verbal language. Others have limited speaking, with imitation which may be of what the interlocutor had just said (immediate echolalia) or from more distant situations (remote echolalia).
It is common the use of the third person instead of ‘I’, the abbreviation of sentences, expression of the strictly necessary, ignoring social contact and ‘chatting’. The language presents alteration in the reciprocal discourse, in the comprehension of symbolic language and strange intonation, despite the intact vocabulary and grammar. And, finally, there is limited imagination; continuous repetition of movements, routines or specific activities; drastic behavior reactions before changes as, for example, replacing an object in the house; personal rituals; perfection mania; everything must be symmetrical and cannot be out of place. Like to align things, put objects in and out of a box. They have little spontaneity; demonstrate body mimesis, with stereotypical behavior, badly copied from others.
Our hypothesis is that two of these three features (communication difficulty and the absence of sociability) are caused by low behavior-environment interaction, while the third characteristic, the dysfunction in imagination and language, is a form of cognitive compensation, which may develop as resiliency, as in the case of the Aspergic. This, however, does not mean that the ontogenetic and phylogenetic conditioning factors overlap subjectivity and the Self. On the contrary, in the model of Bandura and (so we believe) in the autism symptomatology, conscience is the determinant factor. However, it is also the most variable and flexible factor, adapting to the different types of conditionings.
Autism and Asperger syndrome
Autism was scientifically described first in 1943, by the Austrian doctor Leo Kanner. One may subdivide the development of the studies over the autistic syndrome[2] into three distinct steps: psychogenic phase (or psychoanalytic), in which Autism was understood as an acquired emotional disorder. The behaviorist phase (and vygostskyan), since the 1970s, in which the autism will be seen as an organic-behavioral disorder of biological and hereditary nature (time of the ‘discovery’ of the autistic spectrum[3]). And the current phase, neuro-scientific and cognitivist, in which the genetic, cognitive and environmental factors influence a different brain anatomy. The initial mark of this phase is the clinical research developed by Donald Winnicott over the decisive role of subjectivity in autism.
One can also say that the Asperger Syndrome (AS) is a less serious disorder of the autistic continuum[4]. AS is a disorder of multiple functions of the psyches, mainly affecting the area of interpersonal relationship and communication, while the speech is relatively normal. There are still specific skills and interests, pedantism, stereotyped and repetitive behavior and motor disorders. The aspergic are visual thinkers, literal and inflexible. Oriented by routine and rules, they have a hard time socializing, are quite reliable people and obsessed with their favorite subjects, matters and interests.
At this third stage of research, several partial scientific explanations for the causes of autism have been drawn up, giving emphasis to different aspects: cognitive theories (deficit of executive function, deficit of central coherence, and deficit of Meta-representation), which admit the environmental and innate factors, highlight the role of subjectivity; the hypothesis of food poisoning, which accepts the role of Self and genetics, emphasizing the environment; and the explanations that give priority to the anatomical differences of the brain determined by genetic heredity.
The cognitive theory for the deficit in the executive function is based on the evidence of a compromise on the ability of planning and execution in autism and the similarity between the behavior of individuals with prefrontal cortical dysfunction and those with autism: inflexibility, perseverance, primacy of detail and difficulty of inhibiting responses.
On its turn, the cognitive theory of the deficit of central coherence in representation is an improvement of the executive dysfunction theory which emphasizes the difficulty of processing concepts of abstract totalities and a preference for processing images from concrete partial realities. The cognitive theories have a common characteristic: to assign the social deficits in autism to difficulties in modulate both sensory data and perceptive experience. This way, the autistic ‘retraction’ has been explained in terms of a chronic state of excitement or fluctuations in those states which lead to avoid glances, negative reactions and retraction of social interaction, as mechanisms to control excessive stimulation.
Recovering the notion of innate deficit on the ability to get into affective harmony in autism, identified by the psychoanalytic approaches, also explanation of damage in the ability of meta-represent emerged (or more specifically, the inability to develop a mind with ‘another inside oneself’), as an explanation factor for the autistic spectrum syndromes.
The second major contemporary hypothesis, of food contamination, believes that autism is caused by oxidative stress, inappropriate methylation and sulphatation disorders that reach the brain, provoking what we call autism.
Dr. Amy Yasko is holistic physician and naturopath, works in the USA with a protocol that is done through genetic examinations, based on the genome project and more precisely with epigenetics, science that aim to clarify how environmental factors (dietary habits and stress, for example) may interfere with the functioning of genes. In this perspective, the autistic behavior remains in a tripod that involves the immunologic, intestinal, and endocrinal systems. And the main causes for the autistic disorder are: (a) the presence mercury and heavy metals accumulated in the body; and b) the production of morphines by the body, metabolized from gluten and casein[5]. The protocol is based upon treating autism through the metabolic process of each individual, especially the gluten and casein free diets, vitamin B6 supplements, and use hyperbaric chamber. This hypothesis is embraced by important as organizations such as the Autism Research Institute[6], responsible for the DAN (Defeat Autism Now). Here in Brazil, DAN is represented by ADEFA (Associação Em Defesa do Autismo) and the movement started to be called “autism is treatable”[7]. According to the DAN Protocol there are many issues to be analyzed[8]. Each case has a combination. One may localize the imbalances of the body through specific examinations of blood, urine, feces and mineralogram; and it is prescribed a specific nutritional and biochemical therapy for each case, together with an intensive educational treatment.
And, finally, there are still the approaches that privilege the genetic aspect, considering subjectivity and environment secondary. In April 2008, American College of Medical Genetics (ACMG) established clinical practice procedures to be followed by Clinical geneticists, both to determine the etiology of the cases of disorders from the autistic spectrum and to treat patients with this diagnosis. This study confirms that currently there is a well-established routine, clinically available, with biomarkers that help clinical geneticist to evaluate and treat the individuals, briefly describing some biomarkers identified, important clinical tools identified for medical assessment and response to the monitored treatment[9].
Among the approaches that emphasize the brain anatomical differences, we may highlight Ramachandran, V.S. and L.M. Oberman´s, “Broken Mirrors. A Theory of Autism”, that affirms that the anatomic deficiency on the system of mirror neurons is the cause of autism. The mirrors neurons are responsible for shaping the behavior from the environment and its biological dysfunction would explain the cognitive overload, once the mimesis function would be developed by other parts of brain. Also in this paradigm, there are many such as Oliver Sacks (1995) that no longer consider autism to be a disease but rather a different way to feel and think the world, as valid as any other. Although having a different brain anatomy is not necessarily pathology, for the majority of people, autism is still a serious problem in life and not ‘an alternative way of being’[10].
While naturalist doctors give excessive emphasis on the gluten and casein free diet and radical detoxification of heavy metals; psychiatrists believe the prevalence of genetics/ anatomic difference of the autistic brain; and clinicians, to the hypothesis of cognitive mismatch; each one betting on specific genetic, pharmacologic, or psycho pedagogic therapies. However, the best treatment results are achieved adopting various therapies together – what comes from the conception that believes in a system of multiple determinants and not in one single main cause for the autistic spectrum disorders.
And this leads to our second enunciation: the Social Cognitive Theory, due to its model of reciprocal conditioning between environmental, cognitive and heritable factors, is the ideal philosophy for the integration of treatments and therapies on Autism, through the technique of modeling.
Modeling
The most important theoretical and practical contribution of Bandura is the idea of modeling. Modeling means the adaptation/change by creative mimesis of behaviors, that is, through the reinterpreted imitation of attitudes, gestures, ideas, affections. For him, every social learning is given through modeling of behavior.
The term ‘mimesis’ was used by Plato and Aristotle (and many art researchers and philosophers such as Paul Ricoeur) to designate the same as ‘modeling’: creative apprehension (many times unintended) of others procedures for incorporation into one´s own behavior.
In his early works (1961-1986) concerning social learning theory, Bandura studied the pedagogical role of imitation. In a second moment (1986 until now), he will deepen his studies in order to verify the therapeutic efficacy of imitation, of “transmission of procedures through modeling”, especially in the treatment of psychological phobias and dependencies. However, it is important to cite the famous experience of modeling aggressive behavior with Bopper Bop Buddy[11] In the experience a group of children watched a film with adults (of both genders) shouted and assaulted an inflatable doll. The children were separated and a group of control was not submitted to the movie presentation. In the time that ‘Bop Buddy’ is introduced to the child, they have no hostile attitudes towards the doll. However, after observing the adult having an aggressive behavior with the toy, the children start reproducing the aggressive behavior. Bandura observed that the children who had seen the movie presented the twice aggressive responses compared with the group of control, including inventing new forms of aggression that not had been observed. He also noticed that among those who were exposed to violence, boys were more vulnerable to the aggressive imitation than girls.
Modeling as therapy was originally used by Bandura to work with people with obsessive fear of snakes, making them imitate models of snake exposure, thus overcoming the phobia. Bandura realized that modeling provides both in social learning and in therapeutic re-adaptation, three different effects of change in behavior: the Modeler, interpreter and the observer[12].
It is commonplace to say that autistics, mainly people with AS, copy behaviors, speeches, accents and appearance of others. On the other side, one of the most common symptoms on autism diagnosis is the inability to put oneself in the place of others or even the ability to represent and/or abstract. It may seem contradictory, but the two affirmatives are true: Aspergic are remarkable imitators at the same time that are unable to represent. If our central hypothesis is correct, autistics have difficulty in modeling involuntarily, they need to learn to learn behaviors. The three distinct Bandura effects are simultaneous, but can also be seen as the development steps of the modeling technique for autistic syndromes and the integrated objective of his cognitive training must be the development and expansion of the capacity of meta-representation. Training through modeling incorporates other psycho-dramatic and theatrical techniques.
But let´s get to the point: our second enunciation is that the modeling elaborated by BANDURA is the ideal method for integrating the Autistic disorders treatments.
The ABA (Applied Behavior Analysis) treatment is the main program of intensive instruction of skills necessary to ensure that the individual diagnosed with autism or development invasive disorders may acquire the best life quality possible. Learning opportunities are repeated many times, until the child show the ability without mistake in various environments and situations. The main feature of the treatment is the use of positive or strengthening consequences (gifts, compliments, rewards).
Bandura´s Modeling works with three types of positive reinforcements: past incentive (traditional or classic Behaviorism), promised reinforcement and vicarious or indirect reinforcement, the selective capacity of self-motivation through the choice of the environment, models and reinforcements. Note that these reasons have traditionally seen as the ‘causes’ of learning. Bandura says that they are not determining ‘what’ we learn, but conditioning ‘how’ we learn.
Of course, there are also three negative motivations to imitate: the remembering of punishments, threatening (promised punishment) and vicarious punishment through situations that require great performance or frustrate the apprentice inhibiting undesirable behaviors. Bandura says that the punishment in its various forms, does not work as well as the positive reinforcement and that, in fact, there is a tendency on the restrictions system to go against the development of the learner. By ‘punishment’ one should not understand beating or moral coercion, but consensual penalties assumed in advance, ‘gifts’, compensatory activities conducted spontaneously. The positive use of guilt allied with changes in the forms and occasions for self gratification may accelerate a learning process through modeling. In any case, Bandura´s modeling allows bringing great increment to the ABA treatment on its traditional conception.
In the movie Son-rise: a miracle of love, 1979[13], There is a scene where behaviorist doctors criticize the parents of the protagonist autistic boy because they are imitating his pathological behavior, while ‘the correct’ would be that only the child imitate his parents and teachers. And, as movie shows, the key to get into emotional contact with the autistic child is precisely the modeling reciprocity; the fact of it being two-way is what creates real communication. The great relevance of this approach however, is to prove the central role of affectivity in changing the autistic behavior. And, in the ABA, imitation is unilateral and follows a one-one model of interaction.
Another form of autistic treatment through cognitive training very well known and applied is the TEACCH[14].While ABA is a behavioral therapy that aims to adapt the carrier of the disorder to the social environment, the program TEACCH, more actual, brings an emphasis on the development of the neuro-cognitive difference awareness. Change the behavior is not a goal in itself. It is possible to combine strategies of TEACCH and ABA, however, it is very important for them to be philosophically integrated (By the Cognitive Social Theory, for example). Perhaps those who work with ABA do not emphasize so much the autonomy, sometimes being difficult to avoid that children become dependent on models. On the other side, working with the TEACCH approach may lead to focus too much on independence and cease to work with imitation.
Among the many therapies, there are also combination possibilities, but the most important are: occupational therapy, sensory integration therapy and speech therapy. The integration of therapies can be based in TEACCH and ABA programs. It could also use PECS (Picturing Exchanging Communication System) resources.
I had already acknowledged the educational and therapeutic potential of imitation, due to my experiences with the Repetition Circle. BANDURA, however, makes an impeccable scientific reasoning construction with several empirical researches and many specific discussions.
The Repetition Circle is a technique that consists in imitating together each participant of the circle. The order and the time of participation can be free, in an organic manner; or it may be established a sequence (clockwise, for example) and a specific time (minimum and/or maximum) for each one, but the imitation must be as perfect as possible in terms of movement, voice and intention – highly avoiding to ‘interpret’ the other, although this is inevitable and people end up seeing how they are seen by others. This is not the main function of the exercise, just an initial stage. Over time (about 30 minutes), an unconscious connection among participants is created, and they start to feel their presence in others and the others presence within themselves, and a deep game of exchanging identities and ways of seeing and thinking is established. The Circle involves different applications such as pedagogic (language and music teaching, mythical storytelling), therapeutic (expression of suppressed emotional content, expansion of the individual identity) and hypnotic (imagination travelling – repetition of voices with the eyes shut), although the true essence of this practice is its playful and open to improvisation character. The repetition circle opens the door to countless other circle techniques (Biodanza, circular dances, ring around the rosey), psychodramas, dreams and mythical narratives.
However, in order to promote such integration of treatments and therapies through social learning by modeling of behavior, it is not enough to adopt imitation as primary technique, it is also necessary to highlight the relevant processes of cognitive mimesis:
1. Attention. If you will learn something, you need to be paying attention. Attention is the focus of perception. Some of the factors that influence the attention have to do with the model properties. If the model is colorful and dramatic, for example, have more attention. If the model is attractive, prestigious or appears to be particularly competent it will draw more attention. And if the model is closer to us, it calls further attention. These variables were used by Bandura to measure the effects of television over children.
2. Retention. Secondly, we must be able to remember what we were paying attention to. Here, imagination and language are included, reanimating the image or description so that we may reproduce it with our own behavior.
3. Reproduction. At this point, we are daydreaming. I can spend a whole day watching an Olympic ice-skater and not be able to reproduce his jumps, because I know nothing about skating. It is necessary to have the ability to reproduce the behavior memorized. On the other hand, it is through imitation that one improves its own behavior.
4. Motivation. In addition to pay attention, remember the behavior and knowing how to reproduce them, we still would not modify ourselves unless we have a good reason to do so. As we saw, there are three positive and three negative reinforcements.
“To learn to learn” through observation and modeling of behaviors, implies the ability self-regulation and the learning subject ‘to be an agent’, that is “to make things happen intentionally” (2008, 69) depending on the development, adaptation and change – not only behavior but also on the environment that conditions and determines it.
The idea of Agency
The idea of Agency, more than being defined as mere mediator of environmental and behavioral aspects, has a key role in the constitution of these factors and is formed from four distinct cognitive activities: intentionality, anticipation, self-reactivity and self-reflection.
1) Intentionality – In addition to the conscientious desire of change and/or adaptation of behavior, the intention to modify over time implies plans and strategies.
2) – Anticipation – Furthermore, the planning to modify one´s own behavior implies determining goals and foreseeing results.
3) Self-reactivity or self-regulation as a cognitive activity necessary to change of behavior can be subdivided into: a) motivation, this is, the ability to maintain emotionally confident about change, mainly trough beliefs of self-efficacy; and b) actual self-regulation, which for BANDURA is given mainly through modeling (the creative imitation of other models of behavior).
4) Self-reflection – It is consciousness, understood as self-reference and metacognitive ability to reflect about yourself as the main inward factor in social learning process and in adaptive behavior changes.
Agency can still be personal, delegated or collective; but never individual in order to avoid dichotomy with social. In particular, I also do not like collective agency. What is important, however, is that the notion of agency allows to think about the possibilities of increasing the autonomy of the behaviors according to its conditioning, then changing part of this conditioning.
An example: in order to change a diet (to cut sugar and carbohydrates with gluten – which is fundamental to the autistics), a person should, first, understand that the desire is stronger than the will, desiring to have quality of life (or “to stay fit and good-looking”) to win the will to eat candies and pasta, and not the opposite (place the will against the desire to eat it).
But the correct definition of the desire to be intended, avoiding interpreting the restriction as corporal punishment, is not enough without a strategy and a plan involving time, reinforcements, conditioning changes. The faculty of anticipation, on its turn, allows constant redefinition of possible goals and the motivation through the results achieved. The person may, for instance, avoid for some time situations and places that lead to a dietary derange. Self-regulation presents two aspects. Belief that one is able to change habits is preponderant to do so. Many self-help books advise to use the gerund (“I am changing”) or even long-term decision artifice (“I already decided to lose weight and I will no matter how many times I need to start again”). The other aspect is modeling, that is, the imitation of healthy people behaviors: the example of friends who are admired and family support, besides different therapeutic reinforcements, exercising, and other routines. The body learned to eat junk food by modeling and need to learn other behaviors in order to quit the old conditioning.
Self reflection, as sub-function of cognitive agency is the understanding of the excessive consumption of sugar and starch (actually, a dopamine addiction associated to alimentation) as a good opportunity for the mind un-conditioning. Conscience is grateful for the lessons of compulsion; therefore understands its role in the development. Even considering the self-reflection as the most important sub-function in the process of cognitive agency between behavior and environment, Bandura emphasizes self-regulation.
Process of self-regulation (trough contingency self-prescribed)
The process of self-regulation, to BANDURA, begins with self-observation, followed by self-judgment, which enables self-reaction. The cycle of the self-regulation sub-functions is not automatic and the steps only occur when activated selectively and voluntarily by conscience. Bandura prescribes a mental self-observation of medium and long term, based on two groups of parameters: performance dimensions (addiction motivations) and quality of monitoring (how many times and how we observe ourselves). These two parameters allow establishing self-judgment procedures, taking into account our personal standards as well as other performance references (comparisons with others and with one own performance at different times).
Then it may be established the value of the activity observed and whether their determinants are external and/or psychological. From then on, emotional self-reactions of enthusiasm and frustration are evaluated and the punishment and incentives measures required to modify the observed behavior are prescribed. At this point, we realize the importance of the subject's observed/observer system of beliefs. And among the beliefs, Bandura highlight the importance of the belief in one own efficacy as being the most relevant in social learning.
The belief in self-efficacy
To Bandura, among the factors that provide a dynamic self-regulation towards the change in habits and behavior is the belief in self-efficacy, resulting from the expectations of performance and the outcome.
Said like this it may seem ‘positive thinking’ or another self-help illusion, in which by desiring one thing, it happens - as in the movie The secret. However, the self-efficacy is only the judgment of the personal capacity (2008,32) and not a magic or telepathic force capable of influencing events.
While the self-image (or self concept) is a resultant of the past and the self-esteem is rooted in the present emotional situation, self-efficacy is a belief that refers to the future. “Self-efficacy is the judgment of the capacity to organize and perform actions necessary to achieve certain types of performance” (2008,101).
Then, let´s see how the belief in self-efficacy fits into the set Bandura´s ideas. A conscious intensification of this secondary modeling, through the training of social skills is highly recommended in numerous situations, for example when the person is submissive socially and intolerant with the family. Usually this behavior (as well as other alike) is the result of an inappropriate education of people with severe special needs and it can be modified through one-to-one modeling.
However, to people with Asperger syndrome (as well as for other types of high functioning cognitive disabilities in which the carriers have autonomy), the cognitive social theory prescribes self therapy, in which the belief in self-efficacy has a central role. A technique that have been successfully applied to problems such as smoking, eating disorders, chemical dependency and change of habits in general.
It may be subdivided into three procedures:
1. Behavior record. Self-observation requires you to write forms of behavior, both before and after the attempt to change. This includes simple things like counting the food consumption per day until more complex behaviors, such as, for example, every reason for eating them.
2. Environmental planning. Change the environment: eliminate or prevent situations that lead to addiction (television, refrigerator, children). Also to change environment: doing gymnastics, enjoying nature, avoiding bars or programs associated with reckless alimentation.
3. Self-Contracts. Least, there is a declaration of commitment to the change plan, with its rewards and punishments. These contracts must be written in front of witnesses (our therapist, for example) and the details must be very well specified: "I'm going out to dinner on Saturday only if I don't eat junk food this week. Otherwise, I'll stay at home working.” Or similar promises.
In one-to-one, modeling therapies, others (the therapist and parents) control the rewards and punishments to motivate the change in behavior, because people with severe needs are not able to be very strict with themselves. In the self-therapy, however, it is a matter of strengthening even more the agent´s ability of self-regulation, giving the maximum supervised autonomy to ensure a minimum of frustrations and negative experiences. Of course error is part of learning. However, in the development of the belief in self-efficacy is more important to celebrate victories than to reassess unsuccessful attitudes.
Another important policy is to establish the self-efficacy and cognitive disabilities domains and establish targets for difficulties reduction and optimization of capabilities. Following the same example: an autistic believes his efficacy in the mathematical or musical domains and his disability in the field affective and social life.
One could say that the set of domains (efficient and deficient) form a vicious circle of co-recurrent causes in which recurrent situations repeat compulsively and unintentionally. The vicious circle can be reversed through a plan of life excellence, removing and adding reinforcement factors, in order to maximize the self-efficacy domains and minimize the disability domains. And as that the person realizes these repetition patterns, the vicious circle breaks and there is a cognitive reorganization and a progressive change in its internal structure.
In most cases, we should think of a gradual process that begins with the condition of a dependent patient (of the family and the therapist reinforcement) and evolves into the context of an aware agent that struggles to achieve autonomy, transforming as he transforms his environment. Typically, this requires that mothers (and sometimes, fathers and brothers) also get into therapeutic process, training new behaviors.
There are several ways to define the efficiencies and deficiencies, as well as to understand domains and detail them. On the website ‘Coaching Asperger’ there is a list of the eight competitive advantages of Asperger[15]- which is quite interesting, but limited to the professional domain.
From the point of view of schooling (and cognitive development of language and communication), there is actually a strong emphasis on computer usage as prosthesis of the autistic mind[16] and in the fact that there is a great number of people with AS that become programmers ‘naturally’. But when we talk about mental prosthesis is not only a matter of the visual cognition offered by computer syntax, but a matter of the constitution of an identity ‘at distance’ through the Internet, transforming introverted and isolated individuals in a network of social beings, which is a prerequisite not only for an effective social action in a voice in the public arena but, above all, to a change in the autistic behavior and identity[17].The most important of these first groups is the ANI (Autism Network International)[18].
Of course, computers do not replace the dedication of teachers, nor the parental affection and attention. It is only a tool to overcome the triple disability of autism (communication, social interaction and recurrent behavior), an instrument for self-efficacy development. The important thing is the change in attitude.
It is, primarily, through self-representation, that the autistic can develop their autonomy and win the scheme of physical and psychological dependency inherent to their condition.
Conclusion
In addition to perform a brief commented summary of ideas of the contemporary psychologist Albert Bandura, his main concepts were applied here to the treatment of high functioning autism and/or Asperger syndrome.
With the triadic model the autistic behaviors were defined as those who have a disability on direct interaction between behaviors (ontogenetic conditioning), environment (phylogenetic conditioning) and the Self, in which resiliencies, echolalia, recurrences and fixations in the cognitive field develop. We stress also that, in Bandura´s perspective, behavior and the environment are conditioning factors, while the Self, the subjectivity, and the consciousness are determinant factors for cognitive development and social learning.
Then, with the method of social learning through four processes modeling (attention, retention, reproduction and motivation) as the ideal method for the integration of treatments and recovery therapies for people with Autistic disorders: casein and gluten free diet (compiled from clinical examinations), medication (according to the genetic biomarkers) and psycho-pedagogic training of the cognitive representation capacity[19].
With the notion of Agency and its cognitive properties (intentionality, anticipation, self-reactivity and self-reflexivity) considerations of self-regulation (anchored in observation, judgment and self-reaction) from the Social Cognitive Theory were presented.
Finally, we presented the belief in self-efficacy, discussed the techniques of self-therapy (behavior records, environmental planning and use of self-contracts) treating AS treatment, mainly with the use of computers and Internet.
And ended up concluding that: it is through self-representation in its different spheres (social, political and personal) that the autistic can conquer autonomy and a better life within society.
BIBLIOGRAPHY
BANDURA, Albert. Teoria social cognitiva: conceitos básicos. Porto Alegre: Artmed, 2008.
BOSA, Cleonice. Autismo: breve revisão de diferentes abordagens. Revista de Psicologia: Reflexão e Crítica (ISSN 0102-7972) vol.13 n.1 Porto Alegre, 2000.
GODOY, Herminia Prado Síndrome de Asperger: Revisão Bibliográfica. Trabalho de Conclusão de Curso. PUC-SP, 2008.
GOMES, M. B. Um Mapa, uma Bússola - Hipertexto, Complexidade e Eneagrama. Rio de Janeiro: Ed. Mileto, 2001.
SACKS, Oliver. Um Antropólogo em Marte / Sete Histórias Paradoxais. São Paulo: Editora Companhia das Letras, 1995.
RAMACHANDRAN, Vilayanur & OBERMAN, Lindsay. Espelhos Quebrados – uma teoria sobre o autismo. Revista Scientific American Brasil, ANO 5 – Nº 55 12/2006. http://www.sciam.com.br/
RIBEIRO, Valéria Llacer Bastos. Breve análise da cognição da pessoa com autismo e porque o computador tem um papel preponderante na educação da pessoa com autismo. http://euautista.blogspot.com/2009/06/cognicao-visual.html
RICOEUR, Paul. Tempo e Narrativa. Tradução: Constança M. Cesar. 3 volumes. Campinas: Papirus, 1994.
[1] Journalist, Social Communication Professor in UFRN (Brazil), doctor in Social Sciences, Aspergic and editor of the blog Eu, austista? (Me, austistic?) http://euautista.blogspot.com/
[2] ‘Syndrome’ means a set of symptoms of ignored causes
[3] The autistic spectrum is formed by the following syndromes: typical autism, Asperger syndrome, Rett syndrome, Syndrome X Fragile, Landau- Kleffner syndrome, Williams syndrome and childhood disintegrative disorder.
[4] Complete bibliographic review on Asperger. GODOY, 2008. http://euautista.blogspot.com/2009/08/revisao-bibliografica.html
[5] gluten and casein are transformed in peptides, known as gliadino morphine (the fracture of gluten protein) and caseo morphine ( from the fracture of casein protein). These peptides are complex chains of amino acids and require a good operation of enzyme production to be properly broken and absorbed by the organic functions. Both peptides act as the morphine in the body. This happens with people who have fungus problems in the intestine. The theory is that a group of fungi with deregulated growth adhere to the limits of the intestine making it permeable. Substances which are not fully digested can enter the bloodstream and reach the brain. Several studies show that the autistic have both severe deficiencies on enzyme production with little or no production of the enzyme DPP IV responsible for breaking these peptides, and the imbalance of intestinal flora, causing the permeable intestine and letting these substances enter the bloodstream and connect to opiate receptors in the brain. Disability in sulphuring is another factor that contributes to permeable intestine. The glucose-amino-glucan, polysaccharides responsible for maintaining the cellular integrity of intestinal mucosa and of the hemato-encephalic barrier, are dependent on sulphuring. Without sulphuring, the glucose-amino-glucan cannot fulfill their role of maintaining the cellular integrity.
[8] Indicators: levels of secretory IgA reduced; intestinal inflammatory disease; nutritional deficiency, gastro-esophageal reflux; intestinal permeability; heavy metals accumulation, thrombophilia; sensory dysfunction; chromosomal alterations; recurrent measles; opiate presence; melatonin deficiency; nutritional deficits; food allergy; dysimmune brain; change in perfusion; dopamine levels change; altered CMIS; disbiosis; gastritis; high level of ammonia; alteration in Purina levels; changing levels of serotonin; change in sulphiting mechanisms; and deficiency in the levels of Omega 3.
[9] 1. Pofirin biomarker- helps determining whether toxic mercury is present and, when found, monitors alterations in the quantities of mercury, during the detoxification therapies (read: chelation); 2. Trans-sulphatation biomarkers -helps to determine whether there is bio-chemical susceptibility to mercury and when found, monitors the patient's response during nutritional therapy supplementation, such as: methyl-cobalamin (the methyl form of vitamin B12), folinic acid and piroxidin (vitamin B6); 3. The oxidative stress / inflammation biomarkers – help to determine if there are excess of sub-products metabolic ways and when found, monitors the progress of patients during supplementation with anti-inflammatories, such as Aldactone ® (espironolactona); 4. Hormonal biomarkers - helps to determine whether there is hormonal variation, and monitors the progress of patients during the indicated treatment with hormonal regulation drugs such as Lupron ® (leuprolide acetate) and YAZ ® (drospirenone/ethynyl oestradiol); 5. Mitochondrial dysfunction biomarkers- helps to determine if there is disorder in the course of cellular energy production and monitors the progress of patients during supplementation with drugs like Carnitor ® (l-carnitine); and 6. Genetic biomarkers - help to determine if there is genetic susceptibility or causal factors, and provides tips on behavioral changes that reduce the impact of these genetic factors.
[10] For a full bibliographic review on autism v.: BOSA, 2000. http://euautista.blogspot.com/2009/08/revisao-bibliografica-autismo.html
[11] see the video in : http://www.YouTube.com/watch?v=BTB-I-L3YIE
[12] In time and Narrative (1994), the philosopher Paul Ricoeur, confronting Saint Augustine ideas with the thought of Aristotle, also develops a triple theory of mimesis or three levels of reading of the world. Mimesis I is a practical world that haven't yet been explored by poetic activity therefore it has not been narrated yet. This world is already fraught with a pre-narrativity which will serve as reference for the poetic construction (configuration), or mimesis II. The mimesis is not enclosed at the time of configuration (the world of text), but in the reading activity, or, according to Ricoeur, at the time of refiguration, mimese III. In the hermeneutic mimesis, there is a course that comes from the life lived and not yet narrated, goes through the plot configuration and meets the final reader's world.
[13] The movie tells the story of other important therapeutic initiative in the treatment of the autistic syndrome, the Son-Rise Programe ®. At the beginning of the 1970s, the couple Barry and Samahria Kaufman heard from the specialists that there was no recovery for their child Raun. It was from the intuitive and loving dedication that they developed the Son-Rise . Raun did recovered after three years and a half of intensive work with his parents, continued to develop, attended a University and now works in Autism Treatment Center of America . Since then, thousands of children using the program have been developing far beyond expectations, some of them presenting complete recovery.
[14] TheTEACCH (Treatment and Education of Autistic and Communication Handicapped Children) is a special education program directed to the individual learning needs of the autistic child based on daily development. Based on the fact that autistic are often visual apprentices, TEACCH bring a visual clarity to the learning process seeking receptivity, comprehension, organization and independence. Although the TEACCH do not focus specifically on social and communicative skills and as the ABA, it can be used together with this treatment in order to make them more effective.
[16] Prosteshis in two different aspects. The first is that autistic visual cognition is similar with the computer syntax . While the autistic mind ‘run Windows ’,the neuro-typical mind programs itself through an algorithm operating system. There are also some advantages offered by computers in education and treatment of autism: structured environment, foreseeable responses, visual organization, individual self-aid. And there are still four aspects about using the computer in special education that are relevant to its use with Autism: increases the communication ability ; improves cognition; help in activities involving motor coordination; and you it can also help with the education policy of inclusion in regular schools.
[17] Today, besides thousands of blogs of mothers and autistic children, which are multiplying rapidly on the Internet, there are several interesting initiatives being developed in this direction. But there are also practical initiatives such as the idea of a grandfather, John LeSieur, which created a special browser, to his autistic grandson Zackary Villeneuve: the Zac browser. http://www.zacbrowser.com/es/index.html A browser designed specifically for autistic children, whose main objective is for them to interact through games and activities developed especially for them, so that it is easier for their comprehension and understanding, focused on their way of seeing the world (and with dispositives for parental supervision and content control).
[19] For an individualized survey on cognitive, social and personal difficulties, there is a test in: http://euautista.blogspot.com/2009/06/aspie-quiz.html
