Critique of Thurber (2007) 1 Running head: CRITIQUE OF THURBER (2007) A Critique of Thurber, Sheehan, & Valtinson s (2007) Appliance of a Piagetian Framework in Analyzing a Subject with Autism Frederick Herrmann McKendree University October 2008
Critique of Thurber (2007) 2 Thurber, S., Sheehan, W., & Valtinson, G. (2007, March). Autism spectrum conditions from a Piagetian perspective: A case study. Psychology Journal, 4(1), 28-39. Retrieved October 2, 2008, from Academic Search Premier database. Research Question How do the researchers provide a diagnostic evaluation of the 15-year old boy on the ASD spectrum who has been referred to them? Hypotheses If Piagetian constructs are applied, then autism can be classified as a developmental arrest. If the ASD child demonstrates Piagetian stage transition, the child should be ready to move with support to a higher Piagetian stage. Instruments Birth history. Developmental history (psychomotor and language). Family history of neurological disorders (ASD, LD, ADHD). History of previous diagnoses. History of observed behaviors. WISC-III Vineland Adaptive Behavior Scales Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) Various clinical observations and interviews Data Analysis The authors are a clinical child psychologist, a psychiatrist, and a clinical neuropsychologist, thus the evaluation was truly multidisciplinary. The authors synthesized the information from the various sources and compared it with existing theories of autism. For example, they considered the child s inability to follow through with a multi-stage task (setting a table) as the result of weak central coherence (a theory of autism). They also pointed out that this interpretation may be consistent with systemizing Baron-Cohen s theory of autism. The authors took Baron-Cohen s theory to task. (Fortunately, I have recently read one of Baron-Cohen s books, The Essential Difference, in which he describes the female brain
Critique of Thurber (2007) 3 as empathizing, the male brain as systemizing, and the autistic brain as the extreme male brain highly systemizing and non-empathizing.) They point out that when given support, the child responded with reasoning skills, i.e. the child could move beyond systemizing. They also point to WISC-III results indicating that the child has the ability to reason beyond the level of specific details (i.e. beyond systemizing). The authors also re-evaluated the child s previous diagnosis of Asperger Syndrome and the consideration that the ASD diagnosis might be altogether wrong and a schizophrenic diagnosis correct. The Asperger Syndrome diagnosis was found faulty on the basis of the criteria of DSM- IV. The child s high score in verbal intelligence together with his language delay are not consistent with the criteria of Asperger Syndrome. Apart from DSM-IV, the authors also point out that the child showed no interest in social acceptance a characteristic peculiar to ASD children with Asperger Syndrome. The authors interpreted the child s fantasies not as the delusions of a person with a schizophrenic disorder, but rather as the world of a child s imagination. It is perhaps (I can only guess) this consideration which led the authors to hypothesize that autism may be considered a developmental arrest. The child was entertaining a make-believe world which grew in complexity as he aged. Could his cognitive problems also be considered developmental arrests? Ultimately, the authors attempted to fit their data into a Piagetian framework. This worked relatively well (for them). They placed the child s reasoning ability at Piaget s concrete operational stage and the child s egocentricism at Piaget s preoperational stage. The authors also felt his childhood egocentricism would account for his antisocial behaviors. The authors considered that the child s bi-level abilities ( preoperational thought mingling with elements of concrete operations (p. 36)) represent stage transition, i.e. that the child is in the process of moving upwards in his cognitive abilities. Assumptions and Limitations There are no limitations cited per se, yet the authors admit that the use of a case study is accomplished at the expense of reduced external validity (p. 34). However, they argue that the case study provides a more detailed context for exposition of clinical problems than the nomothetic, group research strategies and that the case study includes information of greater practical interest and significance to clinicians (p. 29). They do not assume the child is the typical autistic child, but rather describe him as having a rich personal developmental history in relation to presenting clinical features (p. 29).
Critique of Thurber (2007) 4 Since this is essentially a re-evaluation of the child, previous diagnoses are not assumed to be accurate. The Piagetian cognitive developmental construct is assumed to be a reliable framework within itself. Likewise, proven diagnostic tools, including the ability of the professionals to carry on accurate assessments, are considered valid. Theories of autism ( weak central coherence and systemizing ) are not assumed, but are considered. Data Gathering Certain behavioral characteristics are described, many of which were probably observed simply during contact throughout the evaluation. For example, they describe the child as always walking ahead of others with alacrity, ending conversations abruptly, and responding with confusion to social cues. Other information was probably ascertained from interviews with the child or his parents; for example, that the child had no friends. WISC-III provided verbal and performance and full scale IQs. The Vineland Adaptive Behavioral Scales demonstrated the child could not carry out instructions across multiple experiences (p. 31) (e.g. could not set a table), and the MMPI-A described the child as feeling alienated, misunderstood, and suspicious. Most interesting is the description of the child s fantasy world which must have been elicited during a private interview. He described slaying an invisible person (or creature) named Lugia with whom he had previously bonded. I slew him; I had to. If he had gotten away he would have destroyed the other world. This is the truth. (P. 34) No specific interview questions are listed. Authors Conclusion and Critique The authors felt that their use of the Piagetian construct was both reliable and applicable in clinical practice. The authors concluded that the mingling of Piagetian stages represents stage transition, and that therefore a gradual exposure to peer influences in group therapy might eventually lead to the individual acquiring the ability to consider another s point of view and ponder reality from differing perspectives (p. 36). This conclusion does not seem reliable. First, the idea that the self-centeredness of the autistic individual is child egocentricism in developmental arrest does not explain the child s complete lack of emotional reciprocity or his propensity to looks at persons as things or objects. It seems much more that these emotive neural connections either never properly formed or, in the case of regression, completely failed. This is not the same as developmental arrest.
Critique of Thurber (2007) 5 Second, Piaget s attempt to interpret emotion within his cognitive theory is in very poor standing. Thus, linking preoperational cognitive impediments to emotional deficits may not be sound footing. Finally, exposing the child to group therapy in an attempt to develop a respect for others points of view could apply to any theoretical framework and to earlier stages of the child s life. As I understand it (from my schooling), behavioral treatments for autism are most successful when introduced at the earliest age possible. This includes role playing, etc., aimed at social interaction. The hypothesis itself is interesting: namely, if such a display of mingling characteristics aligns itself with the child s ability to make progress in the suggested areas. This remains to be tested.