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uef.fi

Publications of

the university of eastern finland Dissertations in Education, Humanities, and Theology

Dissertations in Education, Humanities, and Theology

Publications of

the university of eastern finland

Katja DinDar

researching social interaction in autism

Shifting the focus from ’within individuals’ to ’in interaction’

This thesis examines how children with autism spectrum disorder (ASD) participate in social

interactions, and considers how decisions pertaining to research methodology influence the

way social interaction in ASD is understood.

Through the research process, the focus of the thesis shifts from viewing reported challenges in social interaction in ASD as residing ‘within individuals’ towards an interactional approach that appraises their construction ‘in interaction’

with other people.

Katja DinDar

dissertations | Katjadindar | researching social interaction in autism | no 106

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ReseaRching social inteRaction in autism

shifting the focus from ‘within individuals’ to ‘in interaction’

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Katja Dindar

ReseaRching social inteRaction in autism

shifting the focus from ‘within individuals’ to ‘in interaction’

Publications of the University of Eastern Finland Dissertations in Education, Humanities, and Theology

No 106

University of Eastern Finland Joensuu

2017

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Juvenes Print, Suomen Yliopistopaino Oy Tampere, 2017

Sarjan vastaava toimittaja: Vesa Koivisto Myynti: Itä-Suomen yliopiston kirjasto

ISBN: 978-952-61-2548-0 (nid.) ISBN: 978-952-61-2549-7 (PDF)

ISSNL: 1798-5625 ISSN: 1798-5625 ISSN: 1798-5633 (PDF)

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Dindar, Katja

Researching social interaction in autism: shifting the focus from ‘within individuals’

to ‘in interaction’

Joensuu: Itä-Suomen yliopisto, 2017

Publications of the University of Eastern Finland

Dissertations in Education, Humanities, and Theology, 106 ISBN: 978-952-61-2548-0 (print)

ISSNL: 1798-5625 ISSN: 1798-5625

ISBN: 978-952-61-2549-7 (PDF) ISSN: 1798-5633 (PDF)

aBstract

This thesis is concerned with social interactions involving children with autism spec- trum disorder (ASD). Difficulties in social interaction and communication are among the core defining characteristics of the ASD diagnosis. The majority of research on social interaction in ASD has reported that individuals with this diagnosis are severely impaired in their ability or motivation to interact with other people. This thesis takes a critical stance towards the so-called ‘biomedical paradigm’, under which most of such research is conducted. I argue that some of the approaches applied in research based on the biomedical paradigm have contributed towards (re)producing the char- acterisation of individuals with ASD as socially impaired. This thesis considers how studying the behaviour of individuals with ASD in isolation from their social partners, and using methodological approaches that categorise behaviours into predefined cat- egories, tend to focus on disabilities rather than competencies. In doing so, this thesis aligns with critical autism studies in an attempt to interrogate the taken-for-granted knowledge on ASD.

The aim of the thesis is to examine ASD using an interactional approach, focusing on how children with ASD participate in social interactions with their social part- ners, and considering how decisions pertaining to research methodology influence the way social interaction in ASD is understood. The research focuses on some of the core aspects of social interaction, such as gaze behaviours in interaction; establishing, maintaining, and responding to joint attention; and managing interactional trouble to maintain mutual understanding. The approach adopted aligns with a social con- structionist, rather than the biomedical, paradigm in understanding ASD: through the research process, the focus shifts from viewing these aspects as residing ‘within individuals’ towards an interactional approach that appraises their construction ‘in interaction’ with other people. The thesis is organised in a manner that depicts this shift methodologically, demonstrating how my understanding of ASD as a disability residing within an individual gradually changed: I started off by categorising and quantifying elements of a child’s conduct, and then changed my focus to study how children utilise talk, gaze, gestures, and body movements in interactions with their social partners, drawing on the scholarship of conversation analysis (CA).

This thesis consists of four original peer-reviewed articles that have been pub- lished in international journals. The original articles use video and live eye tracking material as their data. The video data was collected during educational task-related interactions between children with ASD or autistic features and their adult social

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partners (parents, club tutors, teachers, special needs assistants, researchers). The live eye tracking data was collected from the children using mobile eye tracking glasses during these interactions.

The findings show that children with ASD can be seen to have competencies in so- cial interaction when their conduct is examined in detailed interactional contexts. This involves paying careful attention to the actions of their co-participants, as opposed to the conduct of these children in isolation. Seeking to identify merely the children’s difficulties, without considering how social partners might contribute to the interac- tions in which they emerge, (re)produces a view that these children lack the skills to participate in social interactions. The original articles show that in actual interactions, social partners participate in multiple ways in facilitating, managing, and, occasion- ally, complicating these situations involving children with ASD. The findings further highlight that rather than attempting to identify and categorise specific predefined ways of interacting, it may be more useful to consider ‘atypical’ forms of interaction and to engage in understanding why they occur at specific moments. These findings have multiple implications for theory, methodology, and practice.

This thesis suggests that research on social interaction in ASD would benefit from an interactional CA approach that can transform how we approach and understand social interactions involving individuals with ASD. In the field of ASD research, this would require a shift from the biomedical paradigm towards an alternative, social constructionist paradigm that views social interactions as actively constructed be- tween participants.

Keywords: autism spectrum disorder, social interaction, social constructionism, in- teractional approach, conversation analysis

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Dindar, Katja

Researching social interaction in autism: shifting the focus from ’within individuals’

to ’in interaction’

Joensuu: Itä-Suomen yliopisto, 2017

Publications of the University of Eastern Finland

Dissertations in Education, Humanities, and Theology, 106 ISBN: 978-952-61-2548-0 (nid)

ISSNL: 1798-5625 ISSN: 1798-5625

ISBN: 978-952-61-2549-7 (PDF) ISSN: 1798-5633 (PDF)

aBstrakti

Tämä väitöstutkimus tarkastelee sosiaalisen vuorovaikutuksen tilanteita, joissa osal- lisina on autismin kirjon lapsia. Vaikeudet sosiaalisen vuorovaikutuksen ja kommu- nikaation alueilla ovat keskeisiä autismidiagnoosia määrittäviä tekijöitä. Valtaosa autismin kirjon henkilöiden sosiaaliseen vuorovaikutukseen keskittyneestä tutki- muksesta on todennut, että autismin kirjon henkilöillä on vakavia puutteita heidän kyvyssään tai motivaatiossaan olla vuorovaikutuksessa muiden henkilöiden kanssa.

Tämä väitöstutkimus suhtautuu kriittisesti niin sanottuun biomedikaaliseen para- digmaan, jonka alla suurin osa tällaisesta tutkimuksesta on toteutettu. Väitän, että osa lähestymistavoista, joita on sovellettu osana biomedikaalista paradigmaa, ovat (uudelleen)tuottaneet kuvaa autismin kirjon henkilöiden sosiaalisen vuorovaikutuk- sen haasteista. Tämä väitöstutkimus tarkastelee, kuinka autismin kirjon henkilöiden toiminnan tarkastelu irrallaan heidän vuorovaikutuskumppaniensa toiminnasta sekä sellaisten metodologisten lähestymistapojen käyttö, jotka kategorisoivat toimintaa en- nalta määriteltyihin luokkiin, johtaa huomion keskittymiseen toiminnan haasteisiin kompetenssien sijasta. Tämän suhtautumisensa osalta tämä väitöstutkimus yhtyy kriittiseen autismitutkimukseen, joka pyrkii tarkastelemaan kriittisesti vakiintuneena pidettyä tietoa autismista.

Tämän väitöstutkimuksen tavoitteena on tutkia vuorovaikutuksellista lähestymis- tapaa hyödyntäen, kuinka autismin kirjon lapset osallistuvat sosiaaliseen vuorovai- kutukseen sekä tarkastella, kuinka metodologiset valinnat vaikuttavat siihen, miten autismin kirjon henkilöiden sosiaalinen vuorovaikutus ymmärretään. Tämä väitös- tutkimus keskittyy seuraaviin sosiaalisen vuorovaikutuksen keskeisiin tekijöihin: kat- seen toimintoihin ja katseen käyttöön vuorovaikutuksessa, jaetun tarkkaavaisuuden luomiseen, ylläpitoon ja siihen vastaamiseen sekä vuorovaikutuksellisista haasteista selviytymiseen henkilöiden välisen yhteisymmärryksen ylläpitämiseksi. Tutkimus so- veltaa sosiaalista konstruktionismia biomedikaalisen paradigman sijasta: tutkimuk- sessa huomionkohde siirtyy näiden tekijöiden tarkastelusta yksilön sisäisinä taitoina vuorovaikutukselliseen näkökulmaan, joka korostaa niiden rakentumista vuorovai- kutuksessa muiden henkilöiden kanssa. Tämä väitöskirja on rakennettu siten, että tämä siirtymä näkyy metodologisesti osoittaen kuinka ymmärrykseni autismista yk- silön sisäisenä pulmana muuttui asteittain: aloitin kategorisoimalla ja kvantifioimalla lapsen toimintaa, mutta huomioni, keskustelunanalyyttistä otetta hyödyntäen, siirtyi siihen, kuinka lapset käyttävät puhetta, katsetta, eleitä ja kehon liikkeitä vuorovaiku- tuksessa muiden henkilöiden kanssa.

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Tämä väitöstutkimus koostuu neljästä vertaisarvioidusta tutkimusartikkelista, jot- ka on julkaistu kansainvälisissä julkaisuissa. Tutkimusartikkelit hyödyntävät aineis- tonaan video- ja silmänliikemateriaalia. Videoaineisto kerättiin osana opetuksellisia tehtäväsuuntautuneita vuorovaikutustilanteita, joissa osallisina oli autismin kirjon lapsia tai lapsia, joilla oli autismin kirjon piirteitä, sekä heidän aikuisia vuorovai- kutuskumppaneitaan (vanhempia, kerho-ohjaajia, opettajia, koulunkäynninohjaajia, tutkijoita). Silmänliikeaineisto kerättiin lapsilta hyödyntäen silmänliikelaseja osana näitä vuorovaikutustilanteita.

Tutkimuksen tulokset osoittavat, että autismin kirjon lapsilla voidaan havaita kom- petensseja sosiaalisen vuorovaikutuksen alueilla, kun heidän toimintaansa tarkastel- laan niissä vuorovaikutuskonteksteissa, joissa se esiintyy. Tämä edellyttää vuorovai- kutuskumppaneiden toiminnan tarkkaa huomiointia, ei ainoastaan lapsen toimintaan keskittymistä erikseen. Keskittyminen ainoastaan lasten haasteisiin ilman, että tarkas- tellaan, kuinka vuorovaikutuskumppanit omalta osaltaan vaikuttavat vuorovaiku- tustilanteisiin ja haasteiden ilmenemiseen, (uudelleen)tuottaa lapsista kuvan, jonka mukaan heiltä puuttuu kyvykkyyttä sosiaaliseen vuorovaikutukseen. Tutkimusar- tikkelit osoittavat, että aidoissa vuorovaikutustilanteissa vuorovaikutuskumppanit osallistuvat monin tavoin sekä vuorovaikutusta edesauttaen että kannatellen lapsia, mutta toisaalta ajoittain hankaloittaen vuorovaikutustilanteita. Tulokset osoittavat myös, että tietyn ennalta määritellyn toiminnan kategorisoimisen sijasta saattaa olla mielekkäämpää tarkastella myös ”epätyypillistä” toimintaa ja pyrkiä ymmärtämään, miksi tällaista toimintaa esiintyy tietyissä vuorovaikutustilanteissa. Näillä väitöstut- kimuksen tuloksilla on niin teoreettista, metodologista kuin käytännöllistäkin sovel- lusarvoa.

Tämä väitöstutkimus esittää, että autismin kirjon henkilöiden sosiaaliseen vuoro- vaikutukseen keskittyvä tutkimus hyötyisi vuorovaikutuksellisesta keskustelunana- lyyttisesta lähestymistavasta, joka voi muuttaa tapaamme lähestyä ja ymmärtää näi- den henkilöiden sosiaalista vuorovaikutusta. Autismitutkimuksessa tämä edellyttää siirtymää biomedikaalisesta paradigmasta kohti vaihtoehtoista sosiaalisen konstrukti- onismin paradigmaa, joka näkee sosiaalisen vuorovaikutuksen vuorovaikutuskump- paneiden välillä aktiivisesti rakentuvana ilmiönä.

Avainsanat: autismin kirjo, sosiaalinen vuorovaikutus, sosiaalinen konstruktionismi, vuorovaikutuksellinen lähestymistapa, keskustelunanalyysi

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acKnoWleDgements

In this thesis, I describe the development in my research as a ‘journey’: how I began to shift from examining social interaction as an ability ‘within’ individuals with au- tism spectrum disorder (ASD) towards focusing on these individuals and their social partners ‘in interaction’. The years spent working on this research have not only been a journey in such a methodological sense but also on a personal level. This journey has led me to know many influential people who have both shaped the pages of this thesis and my life.

I wish to express my gratitude to the participants of this thesis: the children with ASD and autistic features, their teachers, special needs assistants, and tutors. With- out your participation, this research obviously would not have been possible. I am thankful for the time you gave in participating in this project and your acceptance of having your interactions video recorded. Observing and analysing these interactions has taught me a great deal.

I am deeply grateful to my supervisors Dr. Aarno Laitila (University of Jyväskylä), Professor Eija Kärnä (University of Eastern Finland), and Dr. Terhi Korkiakangas (University College London). Your vision, support, and encouragement have been invaluable. Aarno, your clinical perspective and understanding of qualitative research have led to multiple interesting conversations and have deepened the analyses and discussions within the original articles and this thesis. Eija, I truly appreciate the opportunities I have had in working as a researcher in the projects led by you. Your vision for multidisciplinary research is one of the main reasons why this thesis exists today. I have learned a great deal about ASD and special education from you. Terhi, I am thankful to you for sharing your expertise in ASD, in interactional research and, particularly, in conversation analysis. Your contribution has been priceless in shaping my research into what it is. I am grateful for the endless time and effort you have all put into working with me on this research. I hope our collaborations will continue in one form or another in the future.

I feel privileged for having my thesis pre-examined by Dr. Tom Muskett (Leeds Beckett University) and Dr. Tanja Vehkakoski (University of Jyväskylä). I really appreciate your careful and thorough reading of my thesis, and the insightful com- ments and suggestions that have enabled me to improve its final version. I am also deeply grateful for having Professor Anssi Peräkylä (University of Helsinki) exam- ine this thesis and for acting as my opponent. In addition, I wish to thank Profes- sor Kirsi Honkalampi for acting as a custos and guiding me through the practical arrangements of the defence.

My sincere thanks also go to the researchers and students in the Children with Au- tism Spectrum disorders as Creative Actors in a strength-based Technology-enhanced learning Environment (CASCATE) and the Everyday Technologies for Children with Special Needs projects with whom the data for this thesis was collected. I wish to thank the CASCATE project members, Professor Eija Kärnä, Dr. Virpi Vellonen, Dr. Marjo Virnes, and Dr.

Vesa Korhonen, for the collaboration, as well as for the many useful planning meet- ings and discussions over the past few years. I particularly thank Vesa Korhonen for assisting in the collection and management of the live eye tracking data. I also value the opportunities I had in working with Master’s and Doctoral students in Special Education and Psychology during these years. I specifically wish to thank Sanni Kiis-

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kinen, Marita Hirvonen, and Riikka Pekkarinen for working with me to categorise parts of the video data.

I am grateful to the Psychology department of the University of Eastern Finland.

The department, along with its devoted staff, has provided me with a safe nest in which to grow from a Bachelor’s student to a Doctor of Psychology. I also thank the University of Eastern Finland for the opportunity to attend the Erasmus Doctoral Sum- mer School in Eskişehir, Turkey in 2013. These intensive weeks made multiple collabo- rations and friendships possible. Thank you all who were there. I am also thankful for the Special Education department of the Anadolu University (Eskişehir, Turkey) and particularly Professor Atilla Cavkaytar and Dr. Özlem Kaya for organising my Erasmus staff exchange in 2014 and for hosting me as a visiting researcher in 2015.

The time spent at the Anadolu University provided me with beautiful surroundings to both focus on my research, and to learn more and share perspectives on ASD research, education, and rehabilitation in Turkey and beyond. In addition, I wish to thank people at the Hacettepe University Micro-Analysis Network (HUMAN; Ankara, Turkey), including but not limited to Dr. Olcay Sert, Dr. Safinaz Büyükgüzel, and Dr. Ufuk Balaman. I greatly appreciate you and the rest of HUMAN for welcoming me to your data sessions and other activities: you did not only give me new insights about my data and research but also provided me with a (methodological) home in Turkey. Your friendship and these memories are highly valued.

I am also thankful for Dr. Sue Soan for organising my Erasmus teacher exchange in 2014 at the Canterbury Christ Church University (Canterbury, UK). This was an excel- lent opportunity to exchange ideas on ASD research and to plan future collaborations.

My gratitude also extends to the organisers and participants of the EMCA Doctoral Network meetings in 2014 at the University of Edinburgh (Edinburgh, UK) and King’s College London (London, UK) for the valuable feedback and suggestions I received on my data and research. In addition, I would like to acknowledge the seminars of the Life Course in Context doctoral programme at the University of Eastern Finland, which provided another platform for sharing my research with other PhD students and supervisors. I am also grateful for the inclusive atmosphere of the Complexity of (inter)action and multimodal participation research community at the University of Oulu, which made it easier for me to resettle in Finland and find likeminded people when it comes to methodology. I particularly appreciate Dr. Sylvaine Tuncer for your encouragement during the final steps of finishing this thesis.

I have been lucky to walk through my PhD journey with many PhD student col- leagues by my side, some of whom have finished their journeys by now. The space here is too limited to mention you all by name but you know who you are: all the reflective discussions at various seminars, conferences, and summer schools, and during regular working days, are valued. Being able to share this journey with you has made it a far less intimidating experience. I wish to specifically thank Caroline Wahle for being there to share times of joy and sorrow both related and unrelated to research, and Dr. Anne Lindblom for our collaborations and regular stress-relieving discussions. I am also grateful to Dr. Joanne Jalkanen, Hanna-Mari Lahtinen, and Filiz Çiçek for your peer-support and friendship during this journey. In addition, I wish to thank Professor Kati Mäkitalo-Siegl for all your encouragement and friendship.

I also acknowledge with gratitude the financial support I have received during these years. This research, in the form of this thesis, the original articles, and mul- tiple conference presentations in Finland and abroad, was made possible by the Philosophical Faculty of the University of Eastern Finland, the Academy of Finland

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(project 140450), the Alfred Kordelin Foundation, the Olvi Foundation, the Network of Finnish Doctoral Programmes in Psychology, the Emil Aaltonen Foundation, the Finnish Concordia Fund, and the Finnish Multidisciplinary Doctoral Training Net- work on Educational Sciences.

Finally, I wish to thank my family and friends – both those present today and those passed away; both those within and those outside academia – for your encour- agement and belief in me. I appreciate your understanding in my moments of stress when life has been full of nothing but deadlines. I am especially grateful to my friend, colleague, and beloved husband Dr. Muhterem Dindar for sharing this journey with me. It is our mutual interest in research that initially brought us together and for that I am forever grateful. This thesis would not exist without your endless patience and support. Last but not least, I thank our son, Yusuf, whose arrival into this world gave me the motivation and provided the final push for bringing this thesis to its final version. I love you both very much.

Oulu, June 2017 Katja Dindar

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list oF the oRiginal aRticles

The thesis is based on the following original peer-reviewed articles:

I Tuononen, K.1, Laitila, A., & Kärnä, E. (2014). Context-situated communicative competence in a child with autism spectrum disorder. International Journal of Special Education, 29, 4–17.

I I Dindar, K., Korkiakangas, T., Laitila, A., & Kärnä, E. (2016a). Building mutual understanding: How children with autism spectrum disorder manage inter- actional trouble. Journal of Interactional Research in Communication Disorders,7, 49–77.

III Dindar, K., Korkiakangas, T., Laitila, A., & Kärnä, E. (2016b). Facilitating joint attention with salient pointing in interactions involving children with autism spectrum disorder. Gesture, 15, 372–403.

I V Dindar, K., Korkiakangas, T., Laitila, A., & Kärnä, E. (2017). An interactional

‘live eye tracking’ study in autism spectrum disorder: Combining qualitative and quantitative approaches in the study of gaze. Qualitative Research in Psychology, 14, 239–265.

The articles are reprinted with the kind permission of the copyright holders.

author’s contriBution

I am the first author of each of the original articles presented as part of this thesis.

My thesis supervisors, Dr. Laitila, Professor Kärnä, and Dr. Korkiakangas have co- authored the articles. I was a researcher in two research projects between 2010-2014, during which the data for the articles was generated. I am solely responsible for categorising and transcribing the data, and for the statistical analyses. MA Marita Hirvonen (original article I) and MA Riikka Pekkarinen (original article III) assisted me in categorising parts of the video data to assess and calculate the inter-rater reli- ability. The process of qualitatively analysing and interpreting the data, and writing the original articles, took place under the guidance of and in collaboration with the co-authors.

1 Katja Dindar, née Tuononen.

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contents

aBstract ... 5

aBstrakti ... 7

acknowledgements ... 9

list of the original articles ... 13

1 introduction ... 17

2 social interaction in autism ... 21

2.1 Reported social impairments in autism ... 22

2.1.1 gaze in interaction ... 22

2.1.2 Joint attention ... 23

2.1.3 interactional trouble ... 24

2.2 explanations for the reported social impairments ... 25

3 critical aPPraisal of the Biomedical Paradigm ... 27

3.1 Disability approach ... 27

3.2 isolation approach ... 29

3.3 categorisation approach ... 31

4 interactional aPProach to autism ... 34

4.1 outline of conversation analysis ... 34

4.2 Previous interactional research on autism ... 36

5 methodologY ... 41

5.1 objectives of the research ... 41

5.2 Data sources ... 42

5.2.1 Data collection ... 44

5.2.2 Description of the data ... 45

5.3 Participants ... 45

5.4 analytical approaches ... 48

5.4.1 selecting and preparing data for analysis ... 48

5.4.2 categorisation approach ... 50

5.4.3 conversation analytic approach ... 50

5.5 ethical considerations ... 52

5.6 Realiability, validity, and generalisabilty of the research ... 52

6 summaries of the original articles ... 56

6.1 original article i ... 56

6.2 original article ii ... 57

6.3 original article iii ... 58

6.4 original article iV ... 59

7 discussion ... 61

7.1 implications for theory ... 63

7.2 implications for methodology ... 64

7.3 implications for practise ... 65

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7.4 limitations and future directions for research ... 67

7.5 conclusions ... 68

references ... 70

original articles ... 81

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list of taBles

Table 1 Results of a demonstrative search for studies on gaze and social interaction in ASD and the proportion of studies utilising a CA approach ... 37 Table 2 Information on children based on their clinical reports ... 47 Table 3 Children scores on NEPSY-II, WMS-III, Sally-Anne task,

SCQ, and SDQ, respectively ... 48

list of figures

Figure 1. Biomedical paradigm and disability, isolation, and categorisation approaches ... 33 Figure 2 The rise of CA studies on ASD from 1990 to current ... 38 Figure 3 The EvTech action stations that are present in original article I ... 42 Figure 4 The CASCATE action stations that are present in the original

articles II-IV ... 43 Figure 5 The SMI eye tracking glasses used in the study ... 44 Figure 6 How a child with ASD is viewed in the biomedical and social

constructionist paradigms ... 61

keY aBBreviations and sYmBols ASD autism spectrum disorder

CA conversation analysis DD developmental delay HFA high-functioning ASD

TD typical development / typically developing

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1 intRoDuction

‘Individuals who are singled out and whose behaviors are rendered meaningful by the diagnosis of autism are not passive agents. Although “the symptoms of their disorder”

have rendered them visible as different and even “disabled” their differences do not preclude their active participation in the self-creation and in the social world.’ (Nade- san, 2005, 210)

I have chosen to begin this section with a citation from Majia Holmer Nadesan, who embraces the social competencies of people diagnosed with autism spectrum disorder (ASD), focusing on what these individuals can do despite being different from typi- cally developing (TD) individuals. Such a view is in striking contrast with how ASD is often described and discussed elsewhere in the literature. Consider the classical description by Leo Kanner (1943) who was, together with Hans Asperger (1944/1991), the first to describe ASD. ‘There is from the start an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes to the child from the outside’ (Kanner, 1943, 242, emphasis in original). Both Kanner and Asperger focus their descriptions of ASD on these individuals’ tendency to shut off relations between themselves and the outside world and to give the impression of being self- absorbed (Asperger, 1944/1991; Kanner, 1943). These disability-focused descriptions are still strongly alive today: ASD is currently understood in biomedical terms as a neurodevelopmental disorder involving developmental deficits that impair the areas of social, personal, academic, or occupational functioning (American Psychiatric As- sociation [APA], 2013). As a diagnostic concept, ASD refers to impairments in the areas of communication and social interaction, and to the presence of restricted, repetitive and stereotyped behaviours (APA, 2013; World Health Organization [WHO], 1992)2. These descriptions show how the ability to exist in relation to others is seen as funda- mentally disturbed in ASD, and how deeply the challenges in social interaction have been, and, indeed, still are considered as one of the core features of ASD.

In this thesis, Thomas Kuhn’s (1970) ideas on paradigm shifts become relevant in considering how certain beliefs, values, and methods in the ASD research community have resulted in approaching ASD in terms of disability, primarily focusing on the challenges these individuals have. This is one of the features of the dominant biomedi- cal paradigm under which the majority of contemporary research on social interaction in ASD is conducted. ‘Biomedical’ does not refer to biological or medical research per se but more to the tendency of locating the identified disabilities ‘within individuals’

with ASD. Moreover, this paradigm involves methodological decisions to approach social interaction in individuals with ASD in individualistic terms (‘in isolation’) rath- er than in interaction with others, which leads to categorising their conduct instead of examining it as part of naturally occurring interactions. The majority of contempo- rary research on social interaction in ASD is quantitatively oriented and focused on

2 However, note that the diagnostic definitions differ in the 5th edition of the Diagnostic and Statistical Manual (DSM-V) and the current version of the International Classification of Diseases (ICD-10). For in- stance, whereas ICD-10 differentiates between Asperger’s syndrome, childhood autism and other sub-types of the disorder, DSM-V uses an overarching category of ASD (APA, 2013; WHO, 1992).

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identifying, categorising, and understanding the variety of social challenges in ASD, in an attempt to find the most fundamental ‘core challenges’ that define the disorder.

This quest constitutes what Kuhn (1970, 24) calls ‘normal science’: the community’s shared activity of ‘extending the knowledge of those facts that the paradigm displays as particularly revealing’, thus resulting in relatively rigid research that seeks to con- firm what the paradigm suggests rather than to discover novelties.

Within the social sciences, Nadesan (2005) and other scholars have started to contest this paradigm: a growing number of critical voices have emerged during the past few years, and currently the field of ASD research contains multiple competing and contradictory views (Milton, 2014). These critical views have fundamentally questioned how ASD is conceptualised and examined (e.g. Davidson & Orsini, 2013;

Milton, 2012, 2014; Muskett, 2016; Runswick-Cole, Mallett, & Timimi, 2016; Solomon

& Bagatell, 2010). The relevance of the research based on the biomedical paradigm has also been criticised by stakeholders, some of whom have been disappointed with research that has focused on finding the ‘core causes’ of ASD, believing it to have little relevance for the day-to-day lives of people with ASD, their families, and communities (Pellicano, Dinsmore, & Charman, 2014). As Simon (2016, 286) puts it,

‘for professionals to point to parts of the brain and insist the knowledge will emerge in the future about the cause of autism is not of much use to people who want to be appreciated and enter into easier communications’. Broadly speaking, these studies have formed what can be called critical autism studies (see e.g. Davidson & Orsini, 2013; O’Dell, Bertilsdotter Rosqvist, Ortega, Brownlow, & Orsini, 2016; Runswick- Cole et al., 2016), taking a critical stance towards taken-for-granted knowledge and its construction in the biomedical paradigm using a variety of mostly qualitatively oriented approaches. In Kuhnian (1970) terms, research on social interaction in ASD today can be seen as experiencing a ‘crisis’: the evidence contradicting the biomedi- cal paradigm has grown large enough for many researchers to engage with new questions and focus on alternative ways of studying social interaction in ASD. Ac- cording to Kuhn, such a phase is marked by competing views, explicit expressions of discontent with the dominant paradigm, and debate over fundamental aspects of the researched topic, all of which characterise the current state of research on social interaction in ASD.

In this thesis, I describe the motivation for shifting from the individualistic view inherent in the biomedical paradigm towards understanding ASD within a social constructionist paradigm. Social constructionism, originally introduced by Berger and Luckmann (1966), is concerned with how knowledge is constructed and understood;

epistemologically it is critical towards the idea of objective, unbiased observations of the reality. Rather, the social constructionist paradigm views knowledge as culturally, historically, and socially specific, and as being sustained by social processes. Thus, for social constructionists, no explanation of reality can be neutral, and cautiousness over one’s assumptions is encouraged (Burr, 2015; Gergen, 1999). Furthermore, the paradigm recognises that there is no one but multiple approaches to social construc- tionism. Gubrium and Holstein (2008) have pictured these different approaches as representing micro and macro levels of social constructionism. At the macro level, there is an interest in collective representations (Gubrium & Holstein, 2008) and power relations (Gergen, 1999). Studies stemming from the poststructuralist strand of social constructionism often represent such interests. On the other hand, social construction- ist studies operating at the micro level focus on talk, situated interaction, and local culture (Gergen, 1999; Gubrium & Holstein, 2008).

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The take on social constructionism in this thesis represents the latter, and relies on a strand of discursive psychology elucidated in the writings of Edwards and Potter (1992; see also Potter & Edwards, 2013; Rapley, 2004). This approach looks at how people work through interactional sequences jointly to achieve mutual understanding and how meaning is essentially constructed in interaction with other people. It thus approaches phenomena traditionally understood as psychological (e.g. an individual’s cognitive states) differently: how these phenomena occur in interactions as situated and occasioned, that is, the ways in which these constructions are invoked in interac- tions (Edwards & Potter, 1992). This paradigm is therefore well suited to challenge the notion that impairments in social interaction reflect pathologies located within the psychology of an individual; instead impairments could be seen as constructed in actual interactions between individuals and should be investigated as such (see Rapley, 2004). Social constructionism can bring new insights into ASD research that has traditionally approached ASD from the biomedical paradigm.

The aim of this thesis is to examine how interactions between children with ASD and their social partners are organised. Knowledge of this organisation can broaden our understanding of both interactional competencies and challenges in ASD, and how these are constructed in interaction with other people. My research approach is interactional, drawing on the scholarship of conversation analysis (CA) (see section 4.1), and, specifically, its multimodal perspective. This thesis sets out both to draw on the interactional approach to examine how children with ASD participate in social interactions, and, in turn, to consider how methodological decisions influence the way social interaction in ASD is understood. In doing so, it also depicts my own journey as a psychologist and researcher: how I shifted from examining social interaction as a set of skills or impairments that reside ‘within individuals’ to acknowledging the value of studying how social interactions involving people with ASD are essentially constructed ‘in interaction’ with other people. The interactional approach adopted is congruent with the social constructionist paradigm in the discursive sense, enabling us to interrogate language as central in constructing concepts such as ‘social competence’

and ‘ASD’ (e.g. Rapley, 2004).

Without downplaying the daily challenges that many individuals with ASD and their families can face, on the pages of this thesis I aim to demonstrate how the interac- tional approach can broaden our current understanding of social interactions in ASD, bringing new insights and tools to approach these phenomena. While I will discuss previous research on social interaction in ASD based on the biomedical paradigm and observe some of the gaps and challenges that exist, this is not done purely to criticise.

In line with critical autism studies, this thesis is essentially intended to encourage rethinking and extending our current understanding of how social interaction in ASD is – and to discuss how it perhaps should be – conceptualised and examined.

There is no universally accepted term to refer to people diagnosed with ASD (Ken- ny et al., 2016). In this thesis, I use the term ‘children with ASD’ to refer to children who have been diagnosed with ASD, and the term ‘children with autistic features’ to refer to children whose biomedical documents describe them as having features of ASD without the actual diagnosis being set. While these children can be viewed as being

‘on the autism spectrum’, I use this distinction for the sake of clarity as these children have not been considered to meet the clinical criteria for ASD. I also on occasion use the term ‘autism’ as a synonym for ASD, such as in the headings of this thesis. There are two reasons for this use of language. Firstly, it is employed for the sake of consist- ency as I adopted it in the original articles found in this thesis. Secondly, the American

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Psychological Association (2010) encourages the use of ‘person-first’ language (i.e. a person with ASD) as it is regarded as more respectful in viewing people as separate from their diagnoses.3

This thesis contains four original peer-reviewed articles that have been published in the International Journal of Special Education, the Journal of Interactional Research in Communication Disorders, Gesture, and Qualitative Research in Psychology. In this sum- mary, I will first review some of the current research on the reported key challenges in social interaction in ASD conducted under the biomedical paradigm, followed by a brief discussion on explanations that have been offered to account for them. I will then move to critically review the biomedical paradigm, interrogating how social interac- tion in ASD has been approached by focusing on individuals’ disabilities and studying them in isolation, leading to a categorisation of their conduct. These observations will be contrasted with the social constructionist paradigm. I argue that these approaches have crucial consequences for how social interaction in ASD is viewed. The interac- tional approach (drawing on CA) will then be introduced, and previous CA work in the field of ASD will be discussed to set the context for the original articles of this thesis. This is followed by a methodology section, describing the decisions regarding participant selection, data collection, and analytical approaches. Next, the four origi- nal articles will be briefly presented, focusing on their findings and methodological reflections. The findings are then discussed and implications for theory, methodology, and practice are considered, together with suggestions for future research, limitations of the thesis, and conclusions.

3 However, it should be noted that ‘person-first’ language is not preferred by all people with ASD and their families (Kenny et al., 2016). Firstly, it is often brought out that ASD is a central part of their identity and something without a negative connotation (Kenny et al., 2016; Sinclair, 2013). People who feel this way commonly prefer ‘identity-first’ language (i.e. an autistic person). Secondly, ‘disorder’ being part of the term ASD can be seen as a remnant of the disability approach that uses biomedical and diagnostic language, and leaves little consideration for competencies. I fully acknowledge that the use of terminology in this thesis is a debatable matter.

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2 social inteRaction in autism

This section will briefly review previous research that has identified challenges related to social interaction in ASD, and discusses the leading theoretical explanations for these challenges. Emphasis will be placed on the methodological aspects of the stud- ies. As communication and social interaction are inevitably intertwined4, children’s abilities in both verbal and non-verbal communication will also be discussed when relevant.

Developmental psychology literature views TD infants entering the world both with the motivation and innate capacity to establish social relationships (Trevarthen, 2011). The first emerging signs include synchronised actions, social smiling, and shar- ing eye contact with a primary caregiver. Later on, these skills develop into more complex social interactions that involve objects and co-participants beyond primary caregivers (Ornstein Davis & Carter, 2014). However, the development of individuals with ASD reportedly follows a different path, and is often characterised by the pres- ence of social difficulties over the lifespan of the individual (Marriage, Wolverton, &

Marriage, 2009).

At the core of these reported difficulties are challenges in managing interaction using multimodal resources (e.g. talk, gaze, gestures). This thesis will zoom in on the use of such resources, including using gaze in interaction, establishing joint atten- tion, and managing mutual understanding. Mutual gaze is crucial in establishing the earliest social interactions, and is assumed to be the driving motivation for infants’

interest in human faces (Gliga & Csibra, 2007). Psychological literature has examined social interaction involving individuals seeking eye contact with their social partners and following the direction of their gaze. Such research has mostly focused on the individual’s perspective, arguing that such gaze behaviours allow one to attend to the same object or event as a social partner, enabling the ability to infer their mental states (Ashwin, Hietanen, & Baron-Cohen, 2015; Baron-Cohen & Cross, 1992). Use of gaze is also proposed to be important for joint attention, which refers to coordinating attention between a social partner and an external object or event, and also involves the shared ‘knowing’ between a child and social partner that their attention is fo- cused on the same concern (Hobson, 2005; Tomasello, 1995). Psychological literature suggests that the difficulties in joint attention may result in breakdowns in mutual understanding and cause interactional trouble. Such situations can be defined as the speakers’ inability to achieve their aim because of co-participants’ misunderstanding or unresponsiveness (Wetherby, Alexander, & Prizant, 1998). The difficulties children with ASD experience in the areas of joint attention and language and communication more broadly (APA, 2013), can, according to Keen (2003), lead them into situations where they are likely to misunderstand and/or be misunderstood by others (see also Wetherby et al., 1998). The intertwined nature of these reported social impairments in ASD makes their joint examination in this thesis relevant.

4 Previously the triad of challenges was taken as crucial for the definition of ASD. However, the new DSM- V (APA, 2013) has made a conceptual change by considering the challenges in communication and social interaction as comprising one area of impairment rather than two distinct areas.

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2.1 rePorted social imPairments in autism

2.1.1 gaze in interaction

Gaze has been a central concern in ASD research. Since the first writings on ASD, gaze behaviours have been described as ‘disengaged and strikingly odd’ (Asperger 1944/1991, 42). Psychological research suggests that children with ASD use their gaze differently than TD children in multiple ways. They look at non-social objects more than socially salient stimuli (e.g. faces) (Falck-Ytter & von Hofsten, 2010; Guillon, Hadjikhani, Baduel, & Rogé, 2014; von Hofsten, Uhlig, Adell, & Kochukhova, 2009), have impairments in orienting to others’ communicative cues (Chawarska, Macari,

& Shic, 2012; Falck-Ytter, Fernell, Lundholm Hedvall, von Hofsten, & Gillberg, 2012;

Fletcher-Watson, Leekam, Benson, Frank, & Findlay, 2009; Gillespie-Lynch, Elias, Es- cudero, Hutman, & Johnson, 2013), are unsuccessful in predicting social events (Ruff- man, Garnham, & Rideout, 2001; Senju & Johnson, 2009; von Hofsten et al., 2009), and, when looking at faces, gaze more frequently at the mouth than the eye region (Hanley et al., 2015; Klin, Jones, Schultz, Volkmar, & Cohen, 2002). The preference for faces and humans in general is reportedly diminished in children with ASD (Riby, Brown, Jones, & Hanley, 2012), who display reduced social attention overall (Chita-Tegmark, 2016). It has been argued that this limits children’s chances for social encounters and experiences, eventually preventing them from developing further social skills (Cha- warska, Volkmar, & Klin 2010; Jones & Klin, 2013). Explanations for these difficulties vary: it has been suggested that for individuals with ASD, the information provided by the eyes may either be less meaningful and socially rewarding (Klin et al., 2002;

Kylliäinen et al., 2012; Ristic et al., 2005), or alternatively, more threatening (Dalton et al., 2005) than for TD individuals.

Previous research has mostly consisted of experimental studies. Methods for as- sessing social visual attention and use of gaze in ASD have involved utilising com- puter-based protocols, as well as observational measures and video recordings. These have included laboratory setups where children are asked to react, often by pressing a button, on seeing certain stimuli (Riby et al., 2012), retrospective studies analysing home videos of children who later received a diagnosis of ASD (e.g. Clifford, Young,

& Williamson, 2007; Maestro et al., 2005) and prospective studies (Leekam, López, &

Moore, 2000; Ozonoff et al., 2010), often during semi-structured assessment situations (e.g. Early Social Communication Scales [ESCS]: Mundy et al., 2003; Social Commu- nication Assessment for Toddlers with Autism: Drew, Baird, Taylor, Milne, & Char- man, 2007). However, such studies have been criticised for their limited accuracy in estimating what exactly the individual is looking at and for how long.

In the past two decades, research has utilised eye tracking equipment to reach more accurate and objective measures of gaze movements. It should be noted that even the most novel studies have produced contradictory findings, likely due to the enormous variation on the autism spectrum and differences in research designs. For instance, some studies have not found an increased duration in looking at the mouth region or a decreased duration in looking at the eye region in ASD (Dapretto et al., 2006; see Falck-Ytter & von Hofsten, 2010 for a review), nor have they found differ- ences between children with ASD and TD children in goal-directed eye movements when observing people’s actions (Falck-Ytter, 2010). There is also evidence to suggest that the variation between the contexts in which these individuals have been examined

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could account for some of the contradictory findings. For example, Charwarska et al.

(2012) found that children with ASD did not show impairments in the use of gaze across settings but, instead, had difficulties in instances involving explicit social cues (i.e. child-directed speech and eye contact). In a similar vein, Falck-Ytter (2015) and Falck-Ytter, Carlström, and Johansson (2015) have found that children with ASD show a reduced tendency to look at an adult’s face during a storytelling situation but not in a cognitive testing situation. It thus seems that contextual elements play a crucial role in understanding the use of gaze in ASD, and deserve more attention in research.

Research on joint attention has included studies in live interactions outside com- puter-based protocols. As the challenges in social interaction in ASD have often been linked with joint attention difficulties, I will move on to consider this area in more detail.

2.1.2 Joint attention

In typical development, joint attention commonly emerges between 8 and 12 months of age (Bakeman & Adamson, 1984; Jones, Carr, & Feeley, 2006). It has been argued that impairments in joint attention are among the earliest and most significant signs of ASD (Charman, 2003; Leekam, 2005). Joint attention skills are perceived as a crucial prerequisite for later social skills, and as being predictive of preschool social and be- havioural competence (Vaughan Van Hecke et al., 2007). These skills are seen as par- ticularly important for language learning: it is difficult to correctly learn what words refer to if mutual focus of attention has not been established. Thus, better joint attention skills also predict better language skills (Charman, 2003). Due to the developmental importance of these skills, they are commonly examined as part of developmental as- sessments. Such examinations are mostly conducted using semi-structured assessment protocols (e.g. ESCS: Mundy et al., 2003), by identifying joint attention behaviours from video recordings (e.g. Clifford et al., 2007; Hurwitz & Watson, 2016), or through parent reporting (Clifford & Dissanayake, 2008; Wimpory, Hobson, Williams, & Nash, 2000).

It has been suggested that children with ASD engage less in smiling, pointing, and seeking eye contact with a caregiver when, for instance, they notice an interest- ing toy, (compared to TD children and children with developmental delays [DD]) (Wong & Kasari, 2012). Overall, research suggests that children with ASD use speech, gestures, and gaze less for intentional communication than TD children and children with DD (Landa, Holman, & Garrett-Mayer, 2007; Maljaars, Noens, Jansen, Scholte,

& van Berckelaer-Onnes, 2011; Watson, Crais, Baranek, Dykstra, & Wilson, 2013).

Furthermore, when they do engage in joint attention, the quality of their initiating behaviours is described as ’unusual’: they rarely coordinate their use of gaze, gestures, and vocalisations, and demonstrate less positive affect in interaction (Ornstein Davis

& Carter, 2014; Kasari, Sigman, Mundy, & Yirmiya, 1990).

As with gaze-related behaviours, here the interactional context also seems to play a role: children with ASD tend to share attention with a co-participant for instrumental purposes (i.e. imperative function), rather than for ’purely’ social ones (i.e. declarative function). Thus, children with ASD are reportedly more likely to coordinate their at- tention to receive help from another person than to share an event they find interesting (Bruinsma, Koegel, & Koegel, 2004; Maljaars et al., 2011). These declarative skills are commonly understood as ‘pure’ joint attention skills, whereas those with an impera- tive function are often referred to as behavioural regulation or requesting (Bruner,

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1981; Mundy et al., 2003). Research also suggests that children with ASD are impaired in responding to joint attention. This argument is based on their decreased follow- ing of others’ eye-gaze, head turns, and pointing gestures (e.g. Leekam, Hunnisett, &

Moore, 1998; Wetherby, Watt, Morgan, & Shumway, 2007), and increased difficulties in understanding others’ gestures, particularly those with higher communicative value (Aldaqre, Schuwerk, Daum, Sodian, & Paulus, 2016).

Despite the evidence for contextual differences in joint attention, relatively little research has considered how interactions unfold in different situations with differ- ent social partners, and how difficulties in joint attention are managed with respect to actual instances of social interaction. When such management apparently fails, it may lead to obstacles in establishing mutual understanding, and thereby possible interactional difficulties.

2.1.3 interactional trouble

It has been suggested that due to difficulties in joint attention, children with ASD may either miss out on others’ attempts to share something with them or misunderstand such attempts (e.g. Keen, 2003). Children might also experience difficulties in attempt- ing to communicate their own intentions to their social partners. Only a few studies have explicitly examined how children with ASD deal with such interactional trou- ble. Methodologically, these examinations have been semi-structured observational studies that have been primarily concerned with how children with ASD respond when confronted with specific requests for clarification, such as ‘What?’ (e.g. Ohtake, Wehmeyer, Nakaya, Takahashi, & Yanagihara, 2011; Volden, 2004).

Research so far suggests that rather than having a general impairment in orienting to interactional trouble, children with ASD particularly struggle when requested to provide clarification (Volden, 2004). For example, Volden, Magill-Evans, Gouldren, and Clarke (2007) found that children and adolescents with ASD were less able than TD peers to simplify their speech according to the perspectives of their listeners. Other studies have found that children with ASD often leave questions directed at them un- answered, and if they do answer, are likely to repeat previous statements rather than provide new information (Capps, Kehres & Sigman, 1998). This suggests that children with ASD may have challenges in understanding and meeting the communicative needs of their social partners.

Despite the fact that children with ASD are reportedly impaired in dealing with interactional trouble compared to their TD peers, they can use multiple strategies to manage these situations, including repetitions, substitutions, and augmentations (Gel- ler, 1998; Keen, 2005; Meadan, Halle, Watkins, & Chadsey, 2006; Ohtake et al., 2005;

Ohtake et al., 2011). However, they also commonly apply unconventional and prob- lematic means, such as pulling a partner’s hand or hitting a partner (Volden, 2004).

Despite the ‘atypical’ form of these means, their use suggests that these children are, nevertheless, aware and attempting to manage interactionally problematic situations (Keen, 2005; Ohtake et al., 2005; Ohtake et al., 2011).

These previous studies have tended to strictly zoom in on the obstacles that indi- viduals with ASD face in managing interactional trouble, thereby studying the indi- vidual in isolation. However, less is known about how social partners contribute to these interactions and how they might perhaps facilitate, or alternatively, complicate the management of such trouble.

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2.2 eXPlanations for the rePorted social imPairments

There are currently multiple explanations for the reported impairments in social in- teraction in ASD. The impairments have been traditionally explained by two, often polarised accounts. These accounts view the challenges in social interaction as stem- ming from impairments in either the cognitive or affective-motivational domains5.

The first account conceptualises the reported impairments in social interaction, and particularly in joint attention, as a representational problem (Baron-Cohen, 1995). It argues that children develop an understanding of not only themselves but also other people as having representations of objects and events. This account holds that the difficulties in joint attention behaviours in ASD relate to impairments in children’s socio-cognitive understanding of other people as having separate mental states (Bar- on-Cohen, 1995; White, Hill, Háppe, & Frith, 2009). It is thus believed that children with ASD have impairments in the cognitive mechanism that constructs the necessary triadic representations of one self, the other, and the object of mutual attention, and therefore fail in ‘mindreading’ and joint attention (Baron-Cohen, 1995).

There are (at least) two variations of this account: the so-called simulation theory and theory theory. Simulation theory argues that people model others’ mental states in their own mind as if they were experiencing them, allowing them to grasp a ‘first- person perspective’ of others’ intentions (Rizzolatti & Sinigaglia, 2010). It is this ability to simulate and experience others’ intentions that is regarded as impaired in ASD. On the other hand, theory theory assumes that others’ behaviours become understand- able to us through a process of theorising about their mental states (Gopnik & Well- man, 1992). This account argues that children with ASD have an impaired ability to theorise about others’ intentions and motivations, causing them to struggle in social interactions. For instance, Baron-Cohen, Leslie, and Frith (1985) have proposed that ASD is linked with an impaired ‘theory of mind’, causing these individuals to experi- ence ‘mindblindness’ (Baron-Cohen, 1995). In support of this, Frith and Frith (2006, 531) argue that ‘experiencing the same emotion as another is not sufficient to infer the cause of that emotion’, but rather through perspective-taking ‘we can infer what a person currently believes about the world given their point of view’. This view sug- gests that such an inferential, ‘third-person perspective’ to another’s mental state is crucial for social interaction, and that this perspective is severely lacking in children with ASD. In Frith and Frith’s (2010, 167) words, ‘if you observe a classically autistic child, then you can see in devastating clarity what it means not to have a spontaneous understanding of mental states’.

On the other hand, the proponents of the affective-motivational account argue that impairments in joint attention are secondary and are essentially rooted in other, more primary deficits. For instance, Hobson (1995) suggests that children with ASD experience early difficulties in interpersonal engagement and lack the affective capacity to engage with others. This then hinders their ability to use symbols and to develop theory of mind. In a similar vein but more recently, Chevallier, Kohls, Troiani, Brod- kin, and Schultz (2013) have proposed that children with ASD have diminished social motivation, which leads them to experience social learning opportunities to a lesser extent than TD children. This, again, reportedly affects the development of their so-

5 There are also theories explaining ASD from a non-social perspective, such as the theories on executive dysfunction (Ozonoff, South, & Provencal, 2007) and weak central coherence (Happé & Frith, 2006). A consideration of these is, however, outside the scope of this thesis.

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cial cognition (Chevallier et al., 2013). Both the cognitive and affective-motivational accounts consider social cognition impaired in ASD, but differ in their view of cau- sality. The cognitive accounts assume that ‘mindblindness’ causes children with ASD to have little interest in social interaction, whereas affective-motivational accounts view ‘mindblindness’ as a consequence of deprived opportunities for interaction (see Chevallier et al., 2013).

In ASD research, these accounts contribute to the ‘normal scientific’ quest (to use Kuhn’s [1970] terms), whereby it is assumed that the reported challenges in social interaction stem purely from ‘within’ the individual child, manifesting their intrapsy- chological impairments. However, Schilbach et al. (2013) argue that these accounts presuppose the theoretical frameworks that they claim to be testing and that their opposing views on causality may actually arise from methodological differences.

Indeed, from a social constructionist perspective, as Rapley (2004) puts it, the taken- for-granted knowledge in ASD can be viewed as a mere product of the means of production of that ‘knowledge’. Thus, these accounts are limited in considering how challenges in social interaction generally attributed to ASD could be constructed in the actual interactions between children with ASD and their social partners.

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3 cRitical aPPRaisal oF the BiomeDical PaRaDigm

This section presents a critical appraisal of the approaches utilised in the biomedical paradigm, examining their role in its current ‘crisis’ and in (re)producing a certain kind of understanding of social interaction in ASD. In doing so, this section enters into a dialogue between different approaches and considers their strengths and limitations in exploring social interaction in ASD within the social constructionist paradigm.

3.1 disaBilitY aPProach

The majority of the previous research on ASD, conducted under the biomedical para- digm, has focused on identifying and describing the impairments and challenges that characterise ASD as a diagnosis. This is also true for children in special educa- tion more broadly: a disability approach (also known as the ‘disability discourse’ and

‘deficit model’ of disability) has characterised the discussion on children with special needs since the beginning of special education (Amstrong, 2012). Thus, children with ASD are often compared against the ‘norm’ set by TD children, resulting in a view where anything departing from this norm is pathologised and interpreted as ‘atypical’

(Milton, 2012). Such an approach is at risk of interpreting anything that a diagnosed person does or does not do as an embodiment of his diagnosis (Goodley, 2001), thereby downplaying the focus on the potential strengths and competencies of that person. It also highlights the idea of disability as an individual’s underlying pathology, focusing on what that individual is unable to do because of their difficulties. The disability ap- proach commonly regards ASD as a cognitive disability (e.g. Baron-Cohen, 2002) that ideally should be treated, the most optimal outcome being full recovery (Anderson, Liang, & Lord, 2014; Fein et al., 2013). Thus, the biomedical paradigm tends to view ASD as a ‘thing’ located within an individual that should be treated in order to reveal the ‘normal’ child underneath. However, such a view contrasts with the social con- structionist paradigm and with the experiences of many individuals with ASD, who describe ASD as a core part of their identity (Sinclair, 2013). This indicates tensions between the disability approach and the view that sees ASD as constructed out of our socially and culturally defined notions of it.

Indeed, the disability approach has been criticised for pathologising people with ASD (e.g. Amstrong, 2012; Conn, 2013), rather than focusing on how the environ- ment and social partners could support them. The latter is often referred to as the

‘social model’ of disability (Oliver, 1983). As Rapley (2004, 55) points out from a so- cial constructionist perspective, there may indeed be multiple difficulties that relate to interactions with people with disabilities but one should not assume that this is the whole story: ‘interactional competence is not a unidimensional, once and for all, all or nothing, property of individual subjects, but rather is only visible in situ, in interaction’. It has not been until quite recently that similar views questioning the disability approach to ASD have emerged. Currently, self-advocates with ASD are perhaps the loudest of such critical voices (e.g. Arnold, 2012; Greenstein, 2014; Milton, 2014). However, people with ASD rarely participate, or are allowed to participate, in producing knowledge on ASD (Milton, 2014), a state of affairs that has not been

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problematised enough by people without ASD (see however Pellicano et al., 2014).

The power imbalance is thus obvious in research conducted within the biomedical paradigm: the views of researchers are commonly prioritised over the first-hand ex- periences of people with ASD.

Self-advocates with ASD have brought in a perspective of ASD as a difference in- stead of disability. This approach, also known as the ‘neurodiversity movement’, consid- ers ASD as something not to be treated nor cured but accepted; society should change and adapt to meet the needs of individuals with ASD (Sinclair, 1993; Singer, 1999).

Some proponents of the neurodiversity movement take ASD as a ‘biomedical fact’

and view ASD as an atypical neurological development that is within ‘normal’ human variation, which – by definition – contrasts with the understanding of ASD found in the disability approach. In other words, individuals with ASD can be described as hav- ing a different, but not impaired ‘brain-wiring’ or ‘cognitive style’ (Armstrong, 2012;

Happé, 1999; Jaarsma & Welin, 2012). According to Davidson (2008), this alternative way of ‘being-in-the-world’ in ASD enables unique cultural experiences and expres- sions, forming what has been referred to among self-advocates as autistic culture.

Critical autism studies have emerged somewhat in parallel with approaches em- phasising difference instead of disability (e.g. Davidson & Orsini, 2013; O’Dell et al., 2016; Runswick-Cole et al., 2016). According to O’Dell et al. (2016), the core of criti- cal autism studies involves emphasising the skills, abilities, and identities of people with ASD, and demonstrating how the dominant approaches to ASD (e.g. disability approach) do not account for them. This description of critical autism studies is well in line with the aims of this thesis. Multiple views exist under critical autism studies, some of which have begun to question the biomedical explanations of ASD. Such views argue that biomedical research has revealed little about the possible biological basis of ASD and have thus began to question its existence (Timimi & McCabe, 2016a).

For instance, Runswick-Cole et al. (2016) argue that ASD should be understood as a fully socially and culturally constructed phenomenon rather than as a ‘thing’ with a biological basis. They have also examined how ASD is constructed, consumed, and sustained as a category, and consequently, as a commodity in contemporary consumer culture (Mallett & Runswick-Cole, 2016), demonstrating that critical autism studies can also have a political focus. However, in line with Nadesan (2005) and other propo- nents of the neurodiversity movement, the differences between children with ASD and TD children can also be viewed as empirically observable phenomena. Understanding ASD as a social construction does not necessitate denying the bodily realities related to the diagnosis or belittling individuals’ experiences (see O’Reilly & Lester, 2015);

yet the socially constructed characterisations of ASD are inevitably never ‘neutral’

or reducible to residing solely ‘within individuals’. Therefore, epistemologically, our means of capturing these differences are limited and guided by the chosen paradigm.

This thesis suggests that rather than focusing on underlying pathology in explain- ing social behaviour, it would be fruitful to shift to questions that have practical rel- evance for people with ASD and their social partners, such as how their interactions are organised, and whether communication challenges could emerge through the participation of all parties in interaction. Thus, it becomes important to examine what people with ASD actually ‘do do’ in naturalistic social interactions rather than relying

‘upon experimental or other artificial encounters’ (Rapley, 2004, 28). The interactional approach therefore contrasts with examinations of social interaction and communica- tion that utilise control and abstraction. These have been particularly visible in the use of an isolation approach that refers to the act of controlling what counts as data

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(Becchio, Sartori, & Castiello, 2010; Edwards & Potter, 1992). In such studies, research participants are required to respond in certain predefined ways (e.g. by ticking boxes in surveys or pressing a button after hearing or seeing particular stimuli on a computer screen). Thus, the isolation approach limits participants’ responses to a set of options decided by the experimenter a priori. Edwards and Potter (1992) are concerned that while this approach enables a reduction of the complexity of data, it can gloss over or wipe out potentially meaningful material (see also Potter & Edwards, 2013). I will consider this in more detail in the next section.

3.2 isolation aPProach

In the current research drawing on the biomedical paradigm, the use of the isolation approach has often resulted in relatively complex experimental tasks that examine social interaction in a somewhat limited manner. The experiments have commonly involved asking participants to observe the behaviour of others. For instance, in the research on gazing behaviours in ASD that was reviewed previously (in section 2.1.1), studies have mostly used either static pictures or dynamic videos as stimuli that the participants are asked to look at. These studies position the participant as a mere recipient of social information (Guillon et al., 2014; Falck-Ytter & von Hofsten, 2011), rather than allowing participation in social interaction with others (see Becchio et al., 2010; Schilbach et al., 2013; Schilbach, 2015). Becchio et al. (2010, 183) have noted how the use of the isolation approach has ‘led to the irony of studies in which social interac- tion is investigated by examining individuals who are physically isolated in separate compartments that do not allow face-to-face interaction’.

Recently, an increasing number of researchers have begun to view social interaction as deeply rooted in the actions of individuals interacting with each other (e.g. Knoblich

& Sebanz, 2008), rather than within individuals and their abilities alone. However, such a view is less prevalent in the biomedical paradigm, which tends to examine social interaction with a near exclusive focus on diagnosed individuals. This means that very little attention is paid to the social context in which they are observed, and the conduct of co-participants (Adamson, Bakeman, Deckner, & Nelson, 2012; Ols- son, 2005; Rapley, 2004; Stiegler, 2007). For example, Kasari et al. (1990, 87) described how children with ASD ‘failed to display high levels of positive affect during joint attention’ (emphasis added). Such an assertion does not recognise joint attention as a mutually established interaction where the actions of the social partner are also crucial (Kidwell & Zimmerman, 2007), nor does it acknowledge the interactional context as a potential source of interactional trouble (Rapley, 2004). Many studies tend to attrib- ute such ‘failures’ to disabilities within a child, rather than investigate how such an instance of ‘failure’ occurs in interaction between a child and social partner, and how displaying positive affect was encouraged or otherwise made ‘relevant’ in the first place. From the perspective of the interactional approach, as Schegloff (1993, 106) puts it, the ‘environment of relevant possible occurrence’ is needed. Thus, even if certain joint attention behaviours are not displayed at a specific moment, it does not mean that they are necessarily missing.

Also, previous research on interactional trouble (such as how children with ASD deal with misunderstandings) has mainly focused on how children with ASD respond when their social partners attempt to solve problems in something that the children have said or done (e.g. Volden, 2004; Ohtake et al., 2011), paying less attention to

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