Uta Frith vs Julian Elliott on dyslexia: and autism

Those familiar with Stephen Pepper’s World Hypotheses: A Study in Evidence, won’t be surprised at Uta Frith’s (FT Pioneering Force 11 October 12 October 2014 ) disagreement with Julian Elliott over the nature of dyslexia and its treatment. They inhabited and continue to inhabit two different worlds of work and therefore possess different mindsets; or is it vice versa?

To illustrate, Uta Frith, as an experimental psychologist / cognitive scientist / cognitive neuroscientist says: “To have a theory, you really need a long period of immersion. You observe and observe and you think”. The clear implication is the need to adopt a (neutral) observer (objectivist) stance characterised by the need to observe, observe and observe before conjecturing a hypothesis which is later tested. But during her course in clinical psychology at the Institute of Psychiatry at the University of London she will have been immersed in a model of human functioning which generally seeks to explain differences among individuals in terms of inherent biological (brain) mechanisms and not contingent interactions. However, Karl Popper pointed out many years ago that in science there are no such entities as interpretation-free observations; for how else does one select what to observe?

By contrast, Julian Elliott, who as an ex-teacher cannot have failed to interact with pupils and students as a participatory observer. He will not have acted in a look-see-think manner. Operating in a presumably pedagogic mode Elliott will have engaged in critical reflection; from the start concerned to induce change in pupils such that they become able to do what they previously couldn’t.

From a meta-perspective Frith’s position is rather paradoxical given the nature of her native German language compared with Elliott’s native English. They can be characterised respectively in terms of ‘the whole is greater than the sum of the parts’ on the one hand and ‘the whole is the sum of the parts’ on the other. English lends itself to an atomistic and mechanistic mindset whereas German lends itself to a holistic and organicist mindset, hence Behaviourist Anglo-Saxon psychology as opposed to Gestalt German psychology. Atomist-mechanicist mindsets treat as separate components the mental, physical, social and emotional facets of individuals; which may or may not interact positively or negatively with each other. The Frith paradox is resolved when it is noted that she entered the world of clinical psychology not as a native Anglo-Saxon speaker. And as anyone who has tried learning to communicate in a foreign language will tell you, comprehending idioms and humour is the most difficult part. It is, therefore, almost inevitable that Frith’s emergent theory was directed not to emotions but to mind – for which read brain.

Nobody, including I suspect Elliott, denies that some children and adults have problems reading and writing fluently. This is not in dispute. What is in dispute is the use of the descriptive labels alexia / dyslexia, which are frequently used as explanations. But this label substitution does not enhance understanding of those trying to handle writing-reading problems. In this context it is interesting to see how Frith resolves the cognitive dissonance generated by the fact that when she used brain imaging, a scanning technique for observing the brain’s neurological processes, it did not yield autism’s secrets. Her early hopes were dashed, and explained away by invoking the ‘research in progress’ mantra. This is often accompanied by the ‘psychology / cognitive science is a young science’ mantra when theory is not confirmed by later observation.

There’s an irony in the mis-match between Frith’s theoretical emphasis on mind rather than emotions and the fact that Elliott & Grigorenko’s underlying message fills her with such dismay that “It makes me feel ill.” Anyone who has watched on television the trouble shooters Gordon Ramsay and Alex Polizzi at work will have noted that the physical, emotional, social and mental are but different facets of individuals and that fundamental change is never achieved without strong emotions being aroused, social interaction getting worse before it gets better and the need to act, rather than merely think differently. Thus in dismissing the evolving interaction between parent (mother / father) – her ‘cold parenting’ theory rejection- in favour of different brain mechanisms, Frith has thrown the baby out with the bathwater. This should be clear from the following three ‘observations’.

At one stage I was working with an ex-long stay hospital adult female who exhibited classic institutionalised autistic features; echolalic speech, avoidance of eye-contact with self and with others, and ritualistic repetitive hand / body gestures. I asked her mother when she first became aware of her daughter’s autism. She replied that when she cuddled her baby in her arms, the baby stretched out to reject her. When I later asked the mother when she first noticed her daughter’s eye-contact avoidance, she replied that when her daughter was a toddler she scribbled over a mirror to avoid seeing herself. From a constructivist and interactionist perspective we have to ask: How many mothers would interpret a baby’s natural stretching as rejection of the mother, and how many would interpret scribbling on a mirror as hiding the reflection? Don’t all babyies stretch when being cuddled and isn’t scribbling over all surfaces, including mirrors, something that almost all toddlers do given a drawing tool? Instead of trying to ‘understand’ her autism her carer and I operated in a progressive problem shifting manner such that we succeeded in reducing her echolalia, such that when asked, “What is your name?” didn’t echo, “Your name” but identified herself by name; was able to look at herself in the mirror and others in the eye, and reduce her stereotypical gestures.

Equally relevantly a recent edition of The New Scientist (10 September 2014) reported the results of a study, under the banner “Early interventions may be effective at treating the symptoms of autism in very young infants.” To quote: “In a pilot study, Rogers and Ozonoff taught the parents of seven infants with symptoms of ASD [Autistic Symptom Disorder], aged between 6 and 15 months old, how to overcome developmental delays through interactions during play, bathing and diaper-changing. Two researchers independently used multiple tests and evaluations to distinguish between infants with symptoms of ASD and those who might just be developing more slowly than average. “These were very symptomatic infants,” says Rogers. “In general these babies did not use their bodies, faces or voices to send and receive messages from their caregivers on what they liked or didn’t like, or wanted more or less of.

Six of the infants began to show accelerated development by 18 months of age, and by the time they were 3 years old, their development was in the normal range, says Rogers. In contrast, four infants who qualified for the study but whose parents chose not to participate continued to show a worsening of ASD symptoms. Rogers speculates that the reason for such a dramatic change is that the programme intervenes when infants’ brains are most plastic, when babies are establishing social skills. She cautions that a large, randomised trial is needed to prove that the intervention works.”

In line with my own work, Lonnie Zwaigenbaum, director of autism research at the University of Alberta in Canada, calls the Rogers and Ozonoff study “a significant study because it demonstrates the ability both to detect symptomatic infants and provide a meaningful intervention prior to 12 months of age.” He says parents and doctors should feel encouraged by this approach as it is specific to autism, rather than a generic treatment drawn from experience with infants with developmental delay. (Note, here I would disagree, such interaction would have wide ranging effects on other conditions too).

The article concluded: “Parents spend much more time with their baby than a professional therapist can, and so are likely to have a greater impact on their development, says Paul Wang, head of medical research at the advocacy group, Autism Speaks, which also supported the study. Because parents can be trained to deliver these interventions, they should be cheaper and more widely available.”

Finally we cannot ignore three issues: first, every condition has a brain correlate so there’s little to be gained by stating that dyslexia and autism are brain conditions, there is however much to be gained by questioning the existence of common co-factors in a variety of conditions – from Frith’s work with dyslexia and autism, through ADHD, depression, dysgraphia, and PTSD to her husband Chris’s work with schizophrenia; second, the role of vested interest parties; and thirdly the role of the media in perpetuating in Elliott’s terms ‘the debate’ and in Stringer’s ‘the myth’ of dyslexia. For it is puzzling that Frith makes no reference to the work of Dr Johanna Barbara Sattler, director of a Consulting Center for Left Handers and Converted Left Handers, in Munich, Germany. Sattler has been responsible for introducing screening converted handedness in all Elementary schools in Bavaria and establishing a network of co-workers. Neither does Chris McManus, author of ‘Right Hand, Left Hand’, who used material from Sattler without acknowledging it!

It is clear from my own experience that there are considerable vested interests at work in sustaining, the industry behind Stinger’s Myth of Dyslexia. In a nutshell the British Psychological Society (BPsS) rejected all my and Sattler’s evidence detailing the phenomenon summarised as the mis-match between the writing hand and the adept hand, its implications for diagnosis and consequences for treatment. The observation of writing with the non-adept hand as a co-factor in so many diverse presenting conditions was so outwith the practice of all psychologists that even though an Associate Fellow the BPsS revoked my Chartered status.

Given the option of saying “One person can’t be right, and the rest wrong” and thus changing the mindset and practices of the majority isn’t an easy one for any organisation to make. But as Bertrand Russell once said, “Even 50 million people can be wrong”. It doesn’t take a rocket scientist or a psychologist to see the reason for at best ignoring and at worst dismissing as yet non-popular view. Think of all the time, money and effort invested in establishing the status quo. Yet challenging the status quo is something that innovators and whistle blowers have to contend with every day.

The issues raised indirectly by Frith are too important to be at best ignored and at worst dismissed by professional academics and practitioners. Yet the media is itself part of each story in so far as what it chooses to report and how it reports it. There is an overriding imperative to declare that far from setting the cause of dyslexia (and other conditions) back, and making us all ill, Elliott’s and Sattler’s work should be more widely disseminated and acted on. Enacting their alternative would save families, institutions and society as a whole incalculable amounts of time, energy and money.

About petermathews

Member of the Royal Society of Medicine
This entry was posted in British Psychological Society, Change agent, Common Ground, Dyslexia, Education, Labelling, Psychologists, autism and tagged , , , , , , , , , , , , . Bookmark the permalink.

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