Saturday, December 11, 2021

Generalization: Is it Worthwhile?

I just came across this article about how to improve generalization of learned skills, and I’d like to discuss some of the example cases and ask a different question - is generalization even desirable?

In particular, I want to focus on Todd and Terry.

Todd has spina bifida. When not in his wheelchair, his preferred means of getting around has long been to scoot along the floor on his butt. When he was 7 years old, his teacher taught him to walk on crutches as a replacement for this behavior, and he was successful in learning to use crutches at school. Reports of this success motivated his parents to get him crutches at home - however, when he came back to school the next year, his skills with crutches had declined, and it turned out that he doesn’t use his crutches at home, preferring to scoot around like he always has.

The article doesn’t really get into the pros and cons of crutch usage for Todd very much. They acknowledge that Todd prefers scooting and theorize that he prefers it because he can scoot faster than he can crutch-walk, but apart from that, it’s taken as a given that crutch-walking is obviously better than scooting. But is this true?

There are a lot of adult wheelchair users who scoot at home, especially paraplegic wheelchair users like Todd. For example, some paraplegic people who live in inaccessible multi-level homes use a wheelchair only for the ground floor, crawl or scoot up or down stairs, and scoot around in the regions of their house that are only accessible from the stairs. Crutches would be far less effective in this particular situation - if Todd maintains his proficiency with bum-scooting, and in particular makes sure he’s able to scoot up or down stairs, he could potentially live in housing situations that would be inaccessible to many other wheelchair and/or crutch users.

Even if Todd does live in a wheelchair accessible home throughout his life, he’ll still have situations where his best option is scooting. For example, what if he’s visiting the pool? He probably won’t want to bring his crutches along while swimming, and crutches left on the poolside could be a tripping hazard. If he wheels or crutch-walks to an out-of-the-way spot, discards his mobility aids and crawls to the water, his mobility aids aren’t obstructing other people’s movements or facing as much risk of being lost or damaged. (If he’s really concerned about the safety of his mobility aids while he’s swimming, he could even use a combination bike lock to affix them to something immobile.)

This article also doesn’t mention what kind of crutches Todd is using. Some designs of crutches can actually be potentially harmful if used long-term - in particular, underarm crutches have been linked to radial nerve palsy. Hopefully, Todd has forearm crutches, which would be more appropriate for a person with a long-term spinal impairment. But underarm crutches are more readily available, and it’s worrying that no mention was made of the kind of crutches Todd uses.

In addition, for his long-term physical health, the best outcome for Todd would be to use a variety of mobility options involving a variety of postures and movements. This would improve physical fitness and reduce risk of pressure sores and muscle strain. Crutch-walking is definitely a good option for him, but so is scooting, and using both in appropriate situations is a better option than choosing one exclusively.

Ultimately, their solution seems to be beneficial to Todd - since Todd could scoot faster than crutch-walk, they encouraged crutch-walking by training him until he could crutch-walk faster than scooting. Learning to crutch-walk faster is undoubtedly beneficial for a child with Todd’s physical abilities. However, their overall approach to his case suggests that they see scooting as an obviously inferior option in all situations, only preferred by Todd because he has more practice with its use, rather than contemplating the potential benefits scooting could serve throughout his life.

Terry’s situation is worse. Terry enjoys hand-flapping and “light filtering” (they don’t specify what “light filtering” is, but I suspect they’re describing a stim I also have, where I move a hand around between my eyes and a light source to see how the light changes as my hand moves). He has been taught to avoid stimming in his elementary school classroom, but still stims in other contexts, and spends most of his recess time stimming. This is seen as a problem.

The fact that they’re setting goals to alter recess stimming highlights a major problem for many disabled children - a lack of true “free time”. Even in times when other children are allowed to freely select their own choice of amusement (as long as it’s not infringing on other children’s rights), disabled children are often given extra rules and expectations. Terry, by virtue of his disability, isn’t allowed to have true free play, because teachers will judge and second-guess his choices of how to play.

Children who stim vary in terms of whether their stimming blocks out attention to other stimuli, doesn’t affect attention, or improves it. If Terry’s stimming blocks out his awareness of other stimuli, then limiting it during educational activities would, actually, be in his best interests. However, if it’s not interfering with paying attention in class, Terry should be allowed to stim in class. Especially since hand-flapping and light filtering aren’t particularly disruptive behaviors, and would be easy for most NT classmates to tune out. (Teachers often greatly underestimate NT classmates’ ability to tune out atypical behavior from disabled classmates, likely partly as an excuse to justify unnecessary attempts at normalizing behavior that actually only bothers the teacher.)

If Terry had a classmate who did find his stimming genuinely disruptive, for example a Deaf classmate who keeps confusing stimming with Deaf-appropriate ways of attracting attention using peripheral vision, then the competing access needs of both students should be addressed in whichever way best serves both of them. This could be suppressing Terry’s stims, if that’s truly the best option, but it could also be changing the seating arrangements so Terry and his Deaf classmate aren’t in the same row (either putting Terry in front or behind the Deaf student could be helpful - and many Deaf students benefit from being in the front row anyway, whereas students prone to sensory overload often benefit from being in a corner), putting some kind of divider between them, encouraging Terry to stim in ways that involve less obvious hand movements, or other options.

In any case, even giving them the benefit of the doubt and assuming that there are genuine reasons why Terry needs to not stim in class, those reasons do not apply to recess, at home, or any other contexts that don’t involve being actively educated or having another person with competing access needs present and unable to freely leave. If Terry uses stimming to block out sensation, for example, this is actually a very adaptive response in situations where he’s risking sensory overload - stimming in recess, for example, could mean that Terry has more energy to attend to class later on, and is less likely to have a meltdown resulting in behavior far more disruptive than just moving his hands in weird ways.

But no, they end up recruiting basically everyone in Terry’s life to suppress his stimming in every context. Which is incredibly harmful - not only does Terry not benefit from suppressing his stims in every context, but he’s also learning that literally no one in his life likes the way he naturally expresses himself. Even if this may not be true - most people in his life likely didn’t really mind his stimming, and only agreed to suppress it because Terry’s teacher has given them the false impression that it helps Terry to suppress his stims in every context.


Blogger Adelaide Dupont said...

About Terry and light-filtering:

Yesterday [18 December 2021] I read a 1976 paper about [hearing-impaired and vision-impaired] rubella children by researcher into deaf-blindness van Dijk

he described diverse behaviours and people - especially when it came to children with bi-lateral cataracts.

He talked about at least two distinct characteristics in the bilateral cataracted rubella subjects which could apply to Terry

"Hands before the lights"

and "Light-gazing".

[this happened when I was searching a linguistic question in Rimland's Form E-2].

9:44 PM  

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