In October, we had a special visit from Studio 3 associate Peter Vermeulen at our headquarters in Alcester, Birmingham.
With 30 years of experience in the field of Autism Spectrum Disorders (ASDs), Peter is a uniquely qualified expert in all things Autism. In a series of talks spanning two days, Peter took us on a journey through the autistic brain, examining what we think we know about autism and behaviour.
Firstly, Peter disputed popular definitions of autism, arguing that autism should not be defined by behaviours that could be described as ‘challenging’. The way we see autism in society and popular culture is far too focused on stereotypical behaviours, and less on why autistic individuals are engaging in those behaviours. As Andy McDonnell states in his book The Reflective Journey, all behaviour is communication, and it is our role as practitioners to interpret what an individual is trying to communicate when their behaviour becomes challenging.
‘There is no such category as ‘autistic behaviours’, only human behaviours’ – Barry Prizant, Uniquely Human
As supporters of autistic people, and particularly as practitioners, we must look beyond behaviour and seek their cause within. For example, everyday stress is a huge factor when it comes to behaviours of concern. Peter asked us, ‘How flexible are you under high levels of stress, and why do we expect more of autistic people?’ He then went on to explain the predictive brain, and why autistic thinking can often lead to stress and loss of control on a neurological level.
The Predictive Brain
Research into the predictive mind has shown that we are not as logical as we often think ourselves to be, and that intuition often trumps reasoning when it comes to our brain processing information (Vermeulen, 2012). Rather than meticulously combing through and analysing sensory information in order to reach conclusions about our environment, which would expend a lot of mental energy, our brain functions mainly on predictions, which occur constantly and unconsciously on a neurological level. This unconscious, fast processing, termed ‘System 1 Thinking’ by Daniel Kahneman, is the primary means by which our brains process information in our daily lives (Kahneman, 2011). The predictive mind is successful with the use of contextual clues and feedback from the senses, which either confirms or denies the predictions the brain has already made (again, this all occurs on an unconscious, cellular level). It is now clear to scientists that perception does in fact start in the brain, and is not dependent on external stimuli from the senses.
Prediction error is the term given to instances in which feedback from the senses suggests that the prediction the brain has made is incorrect (den Ouden, Kok and Lange, 2012). Prediction errors are an unpleasant experience for the brain, and can lead to stress and uncertainty about the validity of future predictions. Therefore, the brain seeks to minimise instances of prediction error by looking only for information that contradicts its predictions. It does so by filtering feedback from the senses to only include information that the brain did not expect to find. It will then adapt its prediction, or interfere with this information, in order to make it fit its expectations.
The weight given to prediction errors - how broad or narrow the margin of error is - is context-specific. Unknown environments are more stressful because they cannot be reliably predicted. Therefore, in unfamiliar environments, more weight is given to sensory information in order to check the validity of predictions. Conversely, when the brain is relaxed and in a familiar environment, the margin of error is wider and less sensory information is required to make accurate predictions.
Context Blindness
So, how does the predictive brain affect individuals with Autism Spectrum Disorders (ASDs)?
Autistic individuals often see the world as a volatile, uncertain, complex and ambiguous (VUCA) place. This is in part due to the autistic brain’s difficulty when it comes to making consistent and reliable predictions. 90% of the predictions autistic brains make are either too broad or too vague (Van de Cruys et al., 2014). In both instances, the predictions are inaccurate, leading to more prediction errors, uncertainty, and stress. The autistic brain is easily surprised, and with that shock comes stress and decreased confidence in its predictions. When the brain lacks confidence in its predictions, it allows for a very small margin of error and places more weight on sensory input, unsure of itself. This means that the autistic brain is often working at the same level of stress and uncertainty as a neurotypical brain would be in a highly stressful and threatening environment. Everyday environments can be highly complex for an autistic brain, and cause a great deal of neurological stress.
This is what Peter refers to as ‘context blindness’ in his book Autism as Context Blindness (2012). Context blindness here refers to a deficit in the flexible adjustments of predictions and their precision in context. The world is incredibly complex for a context-sensitive brain, which can be very inflexible. Autism has been described as ‘absolute thinking in a relative world’, which Peter feels is a more fitting description than behaviour-focused definitions of autism (Van de Cruys et al., 2014). A context-blind brain is over-focused on details and specifics where a more flexible brain is able to recognise consistencies in things that are not distinctly similar. Peter gave an example, stating that dogs differ massively in appearance due to the variety of breeds. Whilst an atypical brain can easily recognise dissimilar looking dogs due to their shared characteristics, an autistic brain is over-focused on their differences, and could fail to recognise that a great dane and a chihuahua are from the same animal family. Peter stressed that autism is not related to IQ or intelligence – a brain can be context blind and still highly intelligent.
Theory Influences Practice
Peter then went on to examine ways in which we can reduce neurological stress for the people we support by seeking to minimise context blindness and thus prediction errors. Contextual lexical priming is one way of putting what is about to happen, e.g. a lesson or an outing, into context, helping the brain to correctly predict outcomes. ‘Pushing the context button’, as Peter refers to it, is a simple way of allowing more processing time as well as narrowing down the type of information being referred to. The key goal is to reduce prediction errors by making things as predictable as possible, and thus making processing less stressful. This can include making schedules and visual plans for the hour, day or week ahead, allowing transition time in between tasks or even ideas to allow for context priming, and speaking in concrete terms to ensure clarity. For example, rather than saying ‘We will go to the park later’, say ‘We will go to the park in half an hour’ or ‘After lunch’. By making things concrete and absolute, you can reduce the stress of searching for the correct context.
Context blindness is also a factor in the social sphere, as a lack of contextual sensitivity in social navigation leads to a lot of what are viewed as ‘autistic behaviours’. For example, facial expressions are highly misunderstood by most people. As with information processing, we read INTO facial expressions what we predict we will see based on the context and how we believe a person will be feeling. Testing an individual’s ability to identify emotions based on close-up images of people’s faces is, Peter explained, teaching them autistic ways of reading facial expressions by ignoring all other stimuli! Instead we should be helping autistic people to identify emotions based not on how they look, but how they feel.
Peter went on to state that, in situations that cannot be controlled or predicted, planned escape scenarios should always be in place to allow coping. Avoidant or escaping behaviours are often a means of communicating an overload of sensory stimuli or limited processing ability. Stress and coping are key to relaxing the context-blind brain, and any intervention should involve mindfulness, palliative (emotional) coping and relaxation methods. Relaxing the brain itself by minimising prediction errors can also reduce overall stress, for example by generating sound. Whilst unpredictable sounds can be stressful for autistic people, generating sound themselves can be soothing, as they are in control of the sensory input their body receives and can therefore reliably predict it. As an example, Peter talked about applause, and how the uncertainty of applause is more stressful for autistic brains than the sound itself. Having spoken to a group of autistic individuals at a conference, Peter discovered that if applause had a set start and end time, it would not be so uncomfortable for the autistic brain. Peter then developed Predictable Applause, a simple solution to this problem which has since been used at autism conferences such as the AsIAm Ireland Conference in 2019!
Knowing what is coming lowers prediction errors, and consequently stress. This is also true for stimming and other physical coping mechanisms, they key being that the individual is in control of their immediate sensory world. Peter reminded us that control is the enemy of anxiety, and giving as much control as possible to the individual will greatly help to reduce their stress. Professor Andrew McDonnell also asserts the importance of relinquishing our control as practitioners in times of stress, and instead enabling the distressed individual to feel as in control as possible (McDonnell, 2019):
‘As someone becomes more stressed, their world becomes more and more narrow until they feel as though they can only control themselves by controlling the world around them. Supporting someone in times of heightened stress to regain a sense of control is fundamental.’ (p. 122)
In conclusion, Peter finished off by saying that autistic brains are ‘precise minds in an uncertain world’. In an autism-friendly world, clearness enables autistic individuals to be in control. Prediction errors on an unconscious, neurological level lead to surprise and stress, which can result in sensory overload and ‘shutdown’. It is important that we as practitioners take stress and sensory discomfort seriously, and address the stress and arousal first before the sensory stimuli. Ask the individual, ‘What would help?’, using positive, problem-solving language. Reduce uncertainty by making the environment more predictable rather than less stimulating. Empower the individuals you support to help them to cope with more experiences rather than teaching them to avoid them altogether. Give (the feeling of) control over the environment, and – most importantly – Peter says we must ‘Give people the freedom to choose what they think is necessary for their needs’.
We finished up the incredibly informative and thought-provoking day with some predictable applause!
We would like to offer a huge thank you to Peter Vermeulen for sharing his knowledge with us all here at Studio 3, and look forward to hearing more from him at our very special 2020 Conference in Kerry, Ireland! Find out more here: www.neart2020.org
Written by Rachel McDermott
Studio 3 Digital Content Editor
References
den Ouden, H. E., Kok, P., & de Lange, F. P. (2012). How prediction errors shape perception, attention, and motivation. Frontiers in Psychology, 3: 548. doi:10.3389/fpsyg.2012.00548.
Kahneman, D. (2011). Thinking, Fast and Slow. New York: Farrar, Straus and Giroux.
McDonnell, A. (2019) The Reflective Journey: A Practitioner’s Guide to the Low Arousal Approach, Studio III Publications. Available to order now: www.studio3.org/product-page.
Prizant, B.M. and Fields-Meyer, T. (2019). Uniquely Human: A Different Way of Seeing Autism. Souvenir Press.
Van de Cruys, S., Evers, K., Van der Hallen, R., Van Eylen, L., Boets, B., de-Wit, L. and Wagemans, J. (2014). Precise minds in uncertain worlds: Predictive coding in autism. Psychological Review, 121 (4): 649-75. doi: 10.1037/a0037665.
Vermuelen, P. (2012). Autism as Context Blindness. United States: Autism Asperger Publishing C0. Available here: https://www.amazon.co.uk/Autism-Context-Blindness-Peter-Vermeulen/dp/1937473007