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2 Psychology courses at Barcelona University
Attendance at numerous courses and seminars in Spain, France, Great Britain on visual impairment, as well as others on psychology and evolution in early childhood.
Computer courses: MS DOS, WordPerfect, DBase IV ...
13 years (1977-1990) in Psychopedagogical
Centre for Sensory Impairments. (CAIXA).
6 years (1990-1996) in Early Attention Service of the Joan Amades C.R.E. (Educational Resources Centre). (ONCE Barcelona).
Initially, my work centred on children of school age, and for the last 8 years I have moved on to the Early Attention field.
From the very start, I have participated actively in all the study and research projects undertaken by our team.
I have also translated numerous works, as well as acting as interpreter at international seminars and exchanges.
1988-1996 at RAMON LLULL
University in Barcelona: Postgraduate course in Special Education.
July 1988 and 1989: Educational Action in Madrid.
July 1992 Summer Courses: Early Attention conference. ONCE Madrid.
Diverse courses and seminars in Cuenca, La Coruña, Tenerife, Barcelona and other Spanish cities.
I am currently working in the vocational training field and am the tutor for Teacher Training, Psychology and Pedagogy students at the Joan Amades C.R.E.
Presentation of papers and
posters at different congresses and conferences, both national and international.
My 18 years of experience, studying and working within the visual impairment field, have permitted me to carry out the following:
- Co-author of the book "Introduction to the study of stereotypies". Edit. Masson. Barcelona 1992, result of research work undertaken by our group.
- Co-author of the book "Early Attention for the blind or visually impaired child. Aspects of intervention". (Pending publication).
- Author of the Collection of Index Cards (5 volumes) of Pre-reading & writing Braille "Point by Point" (Catalan and Spanish versions), published by the ONCE.
- Author of the didactic video "Integration to the Maternal School" presented at the Infancia '93 contest at the Complutense University of Madrid; awarded a special mention.
- Diverse articles in Cuadernos de Pedagogía, Perfiles (ONCE), Integración (ONCE), RTS (Social Workers) and other specialised journals.
- Co-author of the book "Initiation in Language for blind children" (pending publication), result of research carried out with the support of the ONCE.
Our aim is to make known - and thus share by way of this presentation - the work and the results obtained from a study carried out on blind and visually impaired babies and children of between 6 months and 12 years old, all of whom have been attended by our Early Attention Service since they were born.
This research has been carried out by the following members of our team: M. Leonhardt, M. A. Esteban, C. López and M.T. Ferret, under the estimable direction of our Advisor-Paediatrician, Dr. Cantavella. In addition, we were able to count on the invaluable collaboration of Dr. T.B. Brazelton, Professor at Harvard University, who has supported our work with the preface he wrote for the book published to reflect this research.
From the economic standpoint, we received support from the "Fundación Caixa de Pensions" at the initial stage, and from the Spanish National Organisation for the Blind (ONCE) during the second stage.
2.- REASONS BEHIND THIS RESEARCH. Why this particular subject?
After more than 10 years working with blind children, one of the most frequent concerns of our workgroup has been attempting to understand what possible significance could be held by the stereotypies and blindisms that we observe amongst the population we treat; as everyone knows, these symptoms appear on a large scale. This interested us, because we sensed that if we could provide an adequate meaning for such external manifestations, it would help us to penetrate a little more into the internal world of these children. We therefore felt that if we could analyse in greater depth this conduct in a systematic manner, this would allow us to broaden our knowledge of the psychology of the visually impaired, with a view to improving our intervention work.
So, the principal objective of this investigation is to analyse, reflect upon and come to understand the language of these stereotypies, that is, manage to interpret what the blind child is feeling and expressing through such behaviour.
3. - PREVIOUS STUDIES
The existing bibliography on stereotypies and/or blindisms in babies and visual impaired children is rather scarce, particularly if we speak of systematized studies. Nevertheless, we were able to gather documentation from some authors who had considered this question, which proved of great help at the beginning of our analysis. Below, we provide a summary of certain aspects that, in our opinion, are most representative:
Burlingham: "Self" erotic pleasure. Manner of channelling energy arising from lack of movement.
Cutsforth: Lack of stimulation.
Fraiberg: Impasse in development and the difficulty of finding adaptive solutions, in periods of evolution.
Knight: Blocking or returning to primitive motor actions, whenever problems cannot be faced.
Lowenfeld: Not understanding the world that surrounds them. Withdrawal towards their own body, with gratifying results.
Other reference works of importance were the studies of the ethologist Sambrauss, who contemplates six essential states in which the subjects of his study manifest stereotypies:
Social isolation. When movement is restricted. When the environment lacks stimuli. New environments or spaces. When frustration is produced and conflict arises. In boredom situations.
4. - INVESTIGATION APPROACH
In our study we decided to direct this work from 4 perspectives:
1.- To consider the studies
carried out on the stereotypies observed in groups of primates in captivity.
The works of Harlow (1951), Kaufman and Rosenblum (1967) that we obtained
were most interesting, especially with respect to the conduct of the young
that were separated from their mothers. Of interest also were the studies
of Lindsley and colleagues (1964) on the reactions that were observed amongst
the monkeys submitted to visual deprivation.
As for ourselves, we were able to make some observations on animals of this species in the Barcelona Zoo, having received ample documentation and support from the scientific team, and this part of the study proved extremely interesting and most helpful.
2.- Observation of stereotyped conduct and rhythmic movements in a population of 119 sighted children of preschool age, attending Infant Schools in Catalonia.
3.- Statistical study of the data obtained from 55 blind or visually impaired children of between 6 months and 12 years old, attended in our Early Attention Service from the beginning of their lives.
4.- Longitudinal and clinical study of 3 totally, congenitally blind children.
5. - PRIOR HYPOTHESIS
From the data compiled as a result of our experience and from the observations effected, we considered the following hypotheses as possible causes that could provoke mannerisms or blindisms in our population:
1.- The degree of control over the environment.
2. - The degree of demands placed by the environment.
3.- The attention level the child can maintain.
4.- Fears whether justified or not.
5.- Excessively rapid activity rates.
6. - Emotional stresses.
7.- Adaptation to the visual impairment.
8.- Solitude and isolation.
9.- Partial bond or lack of bond between the blind baby and its mother.
10.- Separations from the mother.
11.- Lack of synchrony between the blind baby and its mother.
12.- Lack of suitable educational resources for its evolution.
6. - METHODOLOGY
To achieve greater exactitude in the execution of this study on stereotypies or mannerisms and blindisms, we turned to written observations, periodical video filming, recorded without a concrete purpose in the home of the child or else in the school. Said films were submitted to study and analysis by the whole of the investigating team which, individually, categorized each observation according to criteria drawn up for this purpose. They were then unified and revised, thus determining the reliability of the observations, defined in terms of unanimity.
All the material recorded and analyzed a first time, was once again revised following a certain period of time. The pool of recorded data served to elaborate the final statistical evaluations, from the appropriate correlations.
The period of time employed on this research work was three years.
7.- CLASSIFICATION AND GENESIS OF THE STEREOTYPIES
Under the classification of stereotypies, entities of a very different nature are described, though there are authors who restrict this denomination solely to those referring to motor habits; however, there are others who, without distinction, designate the term mannerisms to this particular kind of stereotypies. In reality, the term stereotypies results vague and excessively general.
The Royal Academy of the Spanish Language defines a stereotypy as the "involuntary, untimely repetition of a gesture, action or word". Etymologically, it originates of the Greek "stereos" which means "solid or firm" and "typos", which means "model or mould".
According to Sambrauss (1985),
the concept of the term stereotypy in Ethology refers to a model or fixed
pattern, in conduct that is produced in a given manner, possesses connotations
of abnormality and includes three certain characteristics:
1.- The model that is produced must be morphologically identical.
2.- It must be repeated constantly in the same manner.
3.- The produced activity does not respond to a certain objective in the execution of the activity.
This third point is most important, with respect to the differentiation of a "normal" or "pathological" stereotypy, since it involves an assessment, on the part of the observer, as to whether a given conduct has an objective or not, taking into consideration the context in which it occurs.
After analyzing the different types of motor, verbal stereotypies etc., as well as revising the existing bibliography, we saw that we had to establish "our classification" in order to be able to define common criteria and observation language, with the classification that was going to be the object of our study ending up as follows:
a) Stereotypies in normal development.
b) Stereotyped parasitic movements.
c) Stereotyped social behaviours.
d) Stereotypies in the form
of: Tics, Motor habits and Verbal habits.
Within Motor Habit Stereotypies: BLINDISMS, OTHER CLASSES.
(PLAY VIDEO S/ STEREOTYPIES IN BLIND CHILDREN)
8.- STATISTICAL RESULTS
A) Graphics: (annexes in the dossier)
1. Types of visual impairment
2. Emotional stability of the family S / conduct
3. Psychomotor development according to the type of visual imp.
4. Intellectual level of the child according to conduct
5. Incidence of stereotypies.
6. Incidence of blindism
7. Prematurity according to blindism
8. Types of blindness according to blindism
We wish to add that we have not observed blindisms in cases of acquired blindness. Nor have tics been observed in the population studied.
B) From the study of 119
sighted children of between 2 and 5 years old, observed in infant schools,
9 children presented motor habit stereotypies, this representing 7.5% of
the population studied, namely 8 boys and 1 girl. As is the case in the
blind group, the male children present more stereotypies.
The data compiled in this observation do not claim to have any statistic value, nor can they provide greater information that what can be deduced from their evaluation. However, for those members of our team who were analyzing these manifestations in visually impaired children, we felt it interesting to have the reference of the sighted children.
D) We present, as an annexe to this investigation, a table reflecting the observation of the age at which blindisms appeared in 10 blind babies:
Age at which blindisms appeared in 10 blind babies observed from their first month of life, considering the etiology of the blindness
Case No. Sex Etiology of
blindness 1st instance of blindisms (age in months)
M Retrolental fibroplasia
Retrolental fibroplasia, microceph.
Primary vitreous hyperplasia 3½ CA
CA: corrected age.
E) With respect to the longitudinal study of the three monographic cases that we analyzed, 2 cases with a normal evolution, and in which motor habit stereotypies and blindisms are present, have been chosen, without this meaning that these conducts could be considered pathological, these children demonstrating a balanced personality. A third case is that of a child, whose stereotypies are autosensorial, having remained blocked without being able to evolve, and not having managed to acquire a minimal degree of meaningful language. In all 3 cases there is a close relationship between the type of bond established with the mother from the beginning of their lives and the evolution of these children.
On the basis of the stereotypy classification established by our team, outlined in section No.7, we can state the following:
- A close statistical relationship is observed between congenital blindness and problematic and maladjusted personality. Congenital blindness is a factor that influences psychomotor development, the personality and intellectual level of the child, being associated to lower levels than is the case for acquired blindness, yet these all appear as a tendency, but not as a determinant.
- On the other hand, it is proven that the emotional stability of the family influences the appearance of stereotypies or also autosensoriality. The latter appears in a greater percentage in those families that have been considered "pathogenic".
- Those children with a slower psychomotor development also tend to present autosensorial movements, the same as those with an inferior intellectual level. On the other hand, the stereotypies are present in a greater percentage of children with a more rapid psychomotor development and also with a good intellectual level.
- We therefore discern a relationship between autosensoriality and congenital blindness, slow development (both motor and intellectual, or both).
- Another factor that presented a high statistical significance is the personality of the child, with respect to his degree of contact with the reality, whilst such behaviour is observed.
- An extremely interesting piece of data is that, in the appearance of blindisms, neither the emotional stability of the family, nor the psychomotor development, intellectual level, personality or sex proved to be significant. On the other hand, variables that indeed did present a statistical relationship with respect to blindisms include prematurity and the type of blindness.
We wish to add our corroboration of the hypotheses formulated at the beginning, namely:
- In all the observed cases, whenever the blind child is submitted to a high degree of control or the environment places many demands on him, and he must maintain a continued high attention level in difficult circumstances in order to perceive events fully, or whenever an excessively rapid rhythm of activity for him is involved, we observe motor habit stereotypies, blindisms or stereotyped parasitic movements. Thus, the latter, which would consist of a sequence of stereotypy discharges, appear with greater frequency in school integration situations, which require a high level of attention and control.
- Once a congenitally blind child begins to perceive his defect as a shortcoming as regards participation in experiences and visual information, he acquires the habit of displaying blindisms when sharing with a sighted person situations in which allusion is made to the visual world. Apparently, such conduct may form part of their adaptation to the blind state.
- Blind children may resort to stereotyped social behaviour in situations that provoke excitation or surprise in them, and they may resort to motor habit stereotypies in situations of greater emotional stress, amongst which frustrations and anxieties principally stand out.
- Weariness due to an excessive consumption of internal energy can be the cause of motor habit stereotypies, especially in younger blind children.
- Movement restriction may be the cause of the appearance of motor habit stereotypies.
- Lack of control in changing situations, attempting be reorganize themselves, may also be the reason for motor habit stereotypies or blindisms.
- The experiences or feelings that induce the child to practise autosensoriality (pathological stereotypies), with all the grave consequences this involves, are:
a) The lack of a bond formed with the mother, or the person that adopts this role, or a partial, excessively fragile formation of same; solitude; isolation; continuous or long-lasting separations; lack of synchrony between the baby and its mother, that is to say, the difficulty she has in comprehending the needs of her child at the very moment the child expresses them.
b) Fears, whether real or not, situations the child is not mentally prepared for as he considers them to be dangerous or an intrusion upon his internal world, may favour the blind child seeking refuge in this type of dissociative conduct.
c) Also conducive to this type of behaviour would be the fact that suitable resources were not provided for the intellectual and motor evolution of the child, thus favouring the stagnation of evolving conduct and provoking a regression to more primitive behaviour in which the stereotypies and blindisms go on to occupy the vast majority of the time the child is awake.
To finish off, we wish to share with you the fact that this work has really helped us to advance in the knowledge and comprehension of the internal world of the visually impaired child. We have managed to understand that the same external manifestation can have a totally different meaning, depending on by whom, how and when it is expressed. Another aspect, no less important, is that being able to understand the meaning of such behaviour permits us to be more "tolerant" when it occurs, thus helping other professionals, with whom we share this work, and especially parents to be able to better "tolerate" such stereotypies in general.
We are aware that this topic is highly complex and difficult, and therefore this study only represents a beginning, our desire being that it may serve as a basis and stimulus for new, wide-ranging research.
Barcelona, 21 June 1996