ENGAGING THE FEELING AND WILL OF CHILDREN WITH AUTISM THROUGH THE MEDIUM OF COLOUR by DIANA MARY PAULI A thesis submitted to The University of Birmingham for the degree of DOCTOR OF PHILOSOPHY School of Education The University of Birmingham March 2004 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. ABSTRACT This is a case study of the role of feeling and will in interaction with children with autism. It investigates the use of changing colours of light for enhancement of engagement at this level. The research was carried out in a specially designed room where the whole interior colour could be changed using dimmer-controlled lights. 19 children aged between 8 and 17 years with a diagnosis of severe autism were involved in the study. Data were collected using video recordings, a research diary and small-scale informal interviews and were analysed by quantitative and qualitative methods. Three main stages were developed. These involved observations of behaviour of children in different colours of light, of children interacting directly with changing coloured light, and of intensive interaction augmented by changing colour moods. The main findings were that colour could affect behaviour and that in general reds were more arousing than blues and greens. Some children engaged readily in interaction with changing coloured lights, though many did not. When changing colour was used in conjunction with intentional creation of affect by an adult during intensive interaction, improvements in social engagement and communication skills were observed. ACKNOWLEDGEMENTS Firstly, I would like to acknowledge the enormous amount of help and support from my supervisor Penny Lacey whose interest and encouragement sustained me through the four years of this research. I would also like to acknowledge Professor Barry Carpenter OBE, for his role in supporting the research. Without his involvement none of this work would have been possible. I am also most grateful to the psychology assistants for their work in preparing the room, note taking and in operating the lights and video camera. My family have had to put up with nearly five years of hard work and endless all-night sessions at the computer, so perhaps most of all I would like to thank them, and especially my husband Roger for all his help and practical support. TABLE OF CONTENTS Page number CHAPTER 1 INTRODUCTION AND OVERVIEW 1 CHAPTER 2 THE NATURE OF AUTISM – A LITERATURE REVIEW 4 The Triad of Impairments 4 Social Interaction in Children with Autism 6 CHAPTER 3 FEELING, WILLING AND SYMBOLISM – A LITERATURE 12 REVIEW The Role of Feeling or Emotion (Affect) 12 The Role of Willing 33 The Role of Symbolic Actions 52 CHAPTER 4 INTENSIVE INTERACTION FOR CHILDREN WITH 54 AUTISM –A LITERATURE REVIEW The Nature of Intensive Interaction 56 Sherborne Developmental Movement 69 Relationship Between Movement and Language 73 CHAPTER 5 OTHER RELATED WORK: THE EFFECTS OF COLOUR 76 AND MULTI SENSORY ENVIRONMENTS – A LITERATURE REVIEW Examples of the Effects of Colour 76 Writings about Colour by Individuals with Autism 79 Colour in Everyday Life and Culture 82 Multi Sensory Environments 83 CHAPTER 6 RESEARCH QUESTIONS AND RESEARCH DESIGN 85 - A LITERATURE REVIEW Development of the Research Questions 85 Research Design 88 Research Design and the Colour Project 103 CHAPTER 7 DESIGN OF THE COLOUR ROOM 107 CHAPTER 8 METHODOLOGY FOR USE OF THE COLOUR ROOM, 111 DATA COLLECTION, ANALYSIS AND RELIABILITY FOR THE FIRST COHORT OF CHILDREN CHAPTER 9 THE CHILDREN INVOLVED IN THE PROJECT 120 CHAPTER 10 OBSERVATIONS OF CHILDREN IN THE FIRST COHORT 128 Observer Reliability in Recording 167 Summary of Outcomes of the First Cohort 176 Page number CHAPTER 11 REVISED METHODOLOGY FOR USE OF THE COLOUR 178 ROOM AND OBSERVATIONS OF CHILDREN IN THE SECOND COHORT Revised Methodology 178 Observations of Children in the Second Cohort, Simon 184 Observations of Children in the Second Cohort, Anna 203 Summary of Outcomes from the Second Cohort 222 CHAPTER 12 METHODOLOGY FOR THE THIRD (INTERACTIVE) 223 STAGE, INTERACTION EXERCISES Eurythmy Movements 224 Other Movement Exercises 229 Procedure for Third (Interactive) Stage 235 CHAPTER 13 METHODOLOGY (INCLUDING A LITERATURE 242 REVIEW) FOR REPORTING AND ANALYSIS OF INDIVIDUAL CASE REPORTS Methodologies for Reporting and Analysing Case Studies- A Literature Review 242 The Colour Project Case Reports 248 CHAPTER 14 CASE REPORTS FOR INDIVIDUAL CHILDREN IN THE 255 THIRD (INTERACTIVE) STAGE Children involved in the third (Interactive) Stage 255 Descriptive Case Report for David 256 Descriptive Case Report for Margaret 267 Descriptive Case Report for Simon 274 Descriptive Case Report for Anna 295 Descriptive Case Report for Alan 308 Descriptive Case Report for Jane 318 Descriptive Case Report for Colin 326 Case Report for Richard 334 Case Report for Geoff 335 Case Report for Benjamin 336 CHAPTER 15 DISCUSSION AND SUMMARY OF FINDINGS FOR THE 337 THIRD (INTERACTIVE) STAGE AND OVERALL CONCLUSIONS The Role of Feelings and Empathy 337 The Role of the Adult’s Willing 340 Summary of General Findings Regarding Quality of Interaction in the Third Stage 344 Summary of Findings, Answers to the Research Questions and Overall Conclusions 347 Evaluation of the Project 349 LIST OF REFERENCES 351 APPENDICES Appendix 1. Examples of note taking in First, Second and Third Stages ii Appendix 2. Video Analysis Recording Sheets, Tables and Statistical Tests for First Cohort xviii Appendix 3. Video Analysis Recording Sheets, Tables and Statistical Tests for Second Cohort lxiv Appendix 4. Additional information: PVCS tests, Coloured Filters, Effect of Temperature c Appendix 5. Notes to accompany the two videos presented with this thesis cviii A note on the two videos (DVDs) follows the contents list. A Glossary of Terms also follows the contents list. LIST OF ILLUSTRATIONS LIST OF FIGURES Figure 7.1 Photograph of colour room in red and blue 107 Figure 7.2 Illustration of colour room design 108 Figure 7.3 Photograph of the coloured shadow screen 109 Figure 12.1 Diagram illustrating eurythmy movement ‘I’ with colours 225 Figure 12.2 Diagram illustrating eurythmy movement ‘A’ with colours 226 Figure 12.3 Diagram illustrating eurythmy movement ‘O’ with colours 226 Figure 12.4 Sketches for eurythmy movements for speech sounds and colours 228 Figure 12.5 Diagram illustrating the ‘In’ and ‘Out’ exercise 230 Figure 12.6 Diagram illustrating the ‘Up’ and ‘Down’ exercise 231 Figure 12.7 Diagram illustrating the colours for the stamping exercise 232 Figure 14.1 Sketch illustrating David’s ‘closed up’ position 257 Figure 14.2 Sketches illustrating the ‘Pink Flower’ exercise 259 Figure 14.3 Lines and colours for the poem ‘I See the Moon…’ 262 Figure 14.4 Sketch of Simon’s finger path for the speech sound ‘O’ 283 Figure 14.5 Sketch of Simon’s hand gesture for the speech sound ‘A’ 283 Figure 14.6 Lines and colours for the poem ‘I See the Moon…’ 285 Figure 14.7 Lines of the chant for the ‘Choosing Sweets’ game with colours 288 Figs 14.8-14.11 Sketches illustrating Alan’s reaction to red, green and yellow 309-311 Figure 14.12 Sketch of the typical position for Colin, covering his eyes with his arm 327 LIST OF CHARTS Chart 10.1-10.5 Charts of Sessions for Brian 133-143 Chart 10.6 Chart of Flicking and Colour for Brian over 3 Sessions 146 Chart 10.7 Chart of Mean flicking Rates in Red, Blue, Green for Brian 149 Chart 10.8 4 Charts Comparing Attentiveness in non-CMD and CMD for Brian 151 Chart 10.9 Comparison of Mean Values Attentiveness non-CMD & CMD for Brian 153 Chart 10.10 Comparison of Attentiveness for 3 Sessions for George 156 Chart 10.11 Mean values for Attentiveness non-CMD and CMD for George 157 Chart 10.12 Detail of Flicking and Vocalisation in Small Section of CMD for Brian 161-164 Chart 10.13-10.15 Charts for Intra- and Inter Observer Reliability 168-173 Chart 11.1-11.4 Charts of Sessions for Simon 187-193 Chart 11.5-11.6 Charts of Looking Up and Down for Simon 195-196 Chart 11.7-11.8 Mean Values for Looking Up /Down for Simon in Red, Blue & Green 197 Chart 11.9-11.10 Charts for Vocalisation for Simon 199-200 Chart 11.11 Mean Values for Vocalisation for Simon in Red, Blue & Green 201 Chart 11.12-11.14 Charts of Sessions for Anna 207-211 Chart 11.15-11.16 Charts of Vocalisation/Rocking for Anna over 3 Sessions 213-214 Chart 11.17-11.18 Mean Vocalisation/Rocking for Anna in Red, Blue & Green 216 LIST OF TABLES Table 9.1 Personal Details & Baseline Abilities for Children Involved in the Project 123 Table 10.1 Personal Details and Baseline Abilities for Brian 130 Table 10.2 Personal Details and Baseline Abilities for George 154 Table 10.3 Personal Details and Baseline Abilities for Christopher 166 Table 10.4 Personal Details and Baseline Abilities for Stuart 166 Table 11.1 Sequence for Computerised Lighting 182 Table 11.2 Personal Details and Baseline Abilities for Simon 185 Table 11.3 Personal Details and Baseline Abilities for Anna 204 Table 11.4 Personal Details and Baseline Abilities