Friday, 15 April 2011

Its rude to point...

Children have an uncanny nack of picking out details and saying the most embarrassing things sometimes - a lack of 'theory of mind' perhaps? Some examples: moustache - "what's that hairy thing on that man's face?", glasses or spectacles - "why is that woman wearing windows?", the list can go on.

In most of these examples, such questions would probably be followed by a very definite pointing of the index finger towards said object/thing/person, just to make sure that everyone knows what is being described and where it is (for maximum embarrassment impact). The usual response is an awkward smile from the parent / caregiver and a gesture or action for the child to stop pointing (the 'inner child' of many adults is though, also having a secret giggle about such childhood observations no doubt). Pointing in these case is socially undesirable.

A lot has been made about pointing - it's various manifestations and uses - with regards to autism. I was interested in this post as to how pointing is potentially related to autism and the link to things like joint attention. What to do about a failure to point, is also of interest. I might add that I won't be discussing pointing with regards to Facilitated Communication in this post.

The first time I came across pointing as being related to autism was upon reading the ADI-R and ADOS instruments used for assessing autism. In ADOS, pointing forms part of various sections of the schedule including the first-stage module 1 assessment (administered to those with no speech) as an indication of language and communication. In the ADI-R 'pointing to express interest' as part of spontaneous communication of interest is also listed; importantly also including coordinated eye gaze. What this suggests is that pointing, or a lack of it, seems to be quite important during the assessment of autism spectrum conditions. Indeed some authors suggest that it is one of the key markers of symptom onset and potentially tied into regression.

I would add at this point out that there are various forms of pointing (not the construction type) related to what meaning is trying to be conveyed. Pointing to indicate interest - "look over there" is known as proto-declarative. Proto-imperative pointing is the "I want that" form of pointing. Pointing therefore, is a means to an end of direct interest but also serves as an 'attention-grabber' for needs and requirement.

The research on pointing and autism is quite bountiful in terms of communication and use of gestures. What it appears to suggest, specifically with regards to autism, is that proto-declarative pointing, the 'social pointing', seems to be the area of most interest.

I suppose this is to be expected in autism given the emphasis (rightly or wrongly) on the social features being paramount. The thing about proto-declarative pointing also is that it bridges communication and social interaction areas of current diagnostic manuals and is perhaps even the prototype behaviour of the proposals on social affect in DSM V (the words 'pointing' though not appearing in the manual revisions so far). I stress the social and communication domains together because pointing in children with autism seems to differ from pointing in children with a language delay.

The question of what to do about it has also been examined. It appears that you can teach a person to point - at least as part of a joint attention programme. Going back to my point above, the question is whether you are teaching pointing as merely a communicative tool or truly as a social-communicative tool.