“Like a two-year-old”…

A colleague reflected the discomfort telling us of the father of a 15-year-okd who had described his son a like a two-year-old… such a provocative comment… so many feelings and thoughts.

Using analogies to infants and children in the intellectual disability world… seems so often to go hand in hand with a tacit response, unspoken but shared.

But not all responses are the same. Not all intentions in uttering the words are the same. Not all interpretations of meaning are the same.

Hoping we can have a conversation to explore the use of age analogies, not to come to the “right” answer, but to understand different perspectives and the thinking (surface and deep) underlying the feelings.

I know I often stand as an outlier in using analogies of age. I know I need to unpack why I do this, and whether I should continue to do so. Can I encourage you to share your thoughts here on this often contentious topic… I will share some of my thoughts as a comment, as to keep the starter post neutral.

11 Comments

  1. Reflecting on my stance on sometimes using developmental age analogies.
    I think babies, infants, and children are amazing communicators. They share attention, they manage when they need breaks by turning away or wringing their hands, they master being coy at 4 months, they tease, they play, they look longingly in eyes, they desire their partner to behave in a certain way, and can let people know when things are working. Good-enough-partners perceive the expressions, support coregulation (knowing how to move from over excited to a calmer excitement or from distressed empathised but supported), help high points and quiet points, provoke and tease kindly to stretch abilities, use voice to teach and to share emotion. I have an enormous respect for early interaction. I do not view interactions with infants as a pantomime of meaningless condescension. For me, if I relate an interaction of an adult with profound ID, I relate it to a skilful dance that requires two partners. For me to relate the use of problem solving, attention, memory (ie cognitive skills), I am not saying an inert, powerless baby, I am saying a skill level that requires partners to attune the way that many skilful parents attune.
    Often when I meet people with severe or profound intellectual disability who use “challenging behaviour”, I see behaviours that make sense from a developmental perspective. Kicking your legs in protest makes sense in the first year… and the response of a parent to look for the reason, empathise to the frustration , and sooth in response makes sense. To be frustrated that you are not leaving the house now for a fun activity for a toddler, by perhaps biting, swiping out, screaming, makes sense to the toddler whose attention, memory and problem solving demands now. The parent who carefully plans when to let the infant know, be ready, to leave, support attention to other things until the time is ready, plan transitional objects to engage attention, and again empathise “you want to go now”, and slowly increase the expectations of coping with transitions is natural. Reflecting on these states can guide more adaptive, effective, and ethical responses to adults who may be experiencing similar states. To recognise the behaviour through a developmental lens can make a lot of sense, to think about the strategies that could avoid the need for situation, and to think of the strategies that slowly build the tolerance of challenging situations, AND the responses to the situation which will either inflame or resolve. A reward program might be unlikely to work if your mindset is here and now feelings. Being “sent to you room” may only inflame frustration. Being told to stop and wait with a firm voice may only serve to make the person feel more alone and unlistened too. Referring to visual program may be meaningless to the person who does not understand the words, the pictures, and how the position of these items of a page are supposed to symbolise things happening. Sometimes I find drawing the parallels to typical development can support teams to look at the situation from a different lens, in particular the lens of what typical good-enough parents do to resolve the natural situation. Of course there are many behaviours, tense situations, life situations that are not helped by bringing in a developmental view. But I do see developmental framing to be an invaluable tool.

    Of course, I must then take responsibility for the implications of my suggestions. I do not want others to say “she’s just like a baby” and pursue engagements that are caricatures of baby-talk, and fail to attune to infant wisdom. I try to write in way that prevents this, but I know the risk is present that the age analogy is taken away from my context. I need to way up the risks and benefits. I test out the waters, particularly with parents to see if it is an analogy that supports a richer understanding of their adult child, and do not pursue it if it offends them. I carefully present the analogy to behaviour support practitioners, sometime of whom have not considered the behaviour through a cognitive-communicative lens which then presses to reflect on whether the suggested strategies have any cohesion with the cognitive-communicative state. Often a deeper understanding is clicked. A recognition that present strategies are misaligned to the person, that strategies analogous to younger child-parent interactions would be more successful. My other consideration is the extent of intellectual disability, my estimation and surety of cognitive communicative equivalences… my observations and assessments are key to making a coherent estimation… I understand that an invalid estimation holds risks… and should only be done in ongoing reflective practices that allow re-estimation should skill estimations be too high or too low – to high, a risk of not being meaningful to the person, too low a risk of insult, condescension, and other horrid things exist. These risks must be acknowledged and checked upon.

    I see risks, benefits, ethical issues… always I am striving for a better understanding of how an individual understands the world and “how do I need to be in order to be with you”… and in many cases, the analogy of typical development is illuminating, when applied alongside the recognition of lives lived, experiences had, trust honoured or dishonoured, attachments made, broken, denied, and hopefully held as the primary ingredient for communication.

    1. Being with the person in a way which makes sense to them whether that be with a baby, an elderly person and all those in between. I guess their actual physical age doesn’t actually matter, it’s about being WITH that person in an uncomplicated, no demands kind of way. Labels are not necessary!

  2. My second comment (hopefully I can find my other one made) is an excerpt of a book my the late Mary Burbidge called Forever Baby – Jenny’s Story – A Mother’s Diary. It lend me the thoughts of a parent. Page12

    “My daughter, my forever baby

    I have a darling baby. A patient placid baby who nuzzles warmly into her sheepskin and gives me a sleepy smile when I come in. She sits up, bounces happily and reaches out for a cuddle. I lift her out of bed, and, with both hands help, she walks unsteadily to the bathroom to have her nappy changed.

    She’s at a delightful stage, liking to help with dressing and underdressing, wanting to hold the spoon but making an awful mess, moving along the furniture and pulling down whatever she can reach. She loves music – songs and rhymes sung to her, banging on the piano, clapping and finger games, adn her never-ending, pull-the-string music boxes. She enjoys being taken for walks on sunny days, snatching the heads off flowers as we pass, and she would splash and laugh forever in a warm bath or pool.

    I’ve had my darling baby for nearly twenty years now, and unless something happens, I guess I’ll have her for another twenty years. She’s been at the lovely seven-to-nine-month stage for a long time, so I don’t expect much change.

    She still has sweet baby face, innocent, unmarred by loss or disappointment or anger, and she still has her mass of blonde curls. But her hormones are those of a young woman – a plum, buxom, almost voluptuous young woman – and acne spoils her pretty face. Her hair, though darker now, is still her finest feature. How often I’ve had cause to be thankful for those lovely curls. People are usually uncomfortable, stuck for something to say, on first meeting my big baby, but they can always say, “What beautiful hair!” And they do. It helps.

    Others I know have a much harder lots with their “forever” babies. Endless years with a fretful, crying child, every mealtime a turmoil of spitting resistance, all activity a cause of spasms and distress. Or a child with full mobility but never learning to heed “no” or “stop”, on the go all day every day, getting bigger and strong with every year, being influenced by powerful adolescent hormones. And without the redeeming beautiful curls”.

  3. Some interesting thoughts I’ve not considered before. I guess I usually avoid making age comparisons as I don’t always find it useful or helpful. I am keen to describe the communication and interaction styles of people as a reflection of them at that time. I consider that a person is first and foremost a person of the age that they are- with history and experiences in some ways similar to that of others of the same age. The way they communicate and interact I then like to describe specifically reflecting them. I feel that adults with disabilities are often considered to be children and their experiences minimized- that I try to help others remember and understand that they are adults deserving of respect.

    Interestingly- I think this is also tied to the fact that children are often not respected or understood in our society. I would probably be more inclined to make age comparisons if by saying that a person ‘is like a child’ that you weren’t also suggesting that they are a person that doesn’t deserve the he same level of respect or agency than what we would give an adult.

  4. Whenever the topic of respectful language, terminology, nomenclature or similar topics comes up I usually end up with a default position that coming from a place of respect generally trumps specific verbiage and I find this piece highly respectful.

    Given the right time and context conversations drawing parallels between a child’s non-verbal language with an adults non-verbal language can be powerful if done correctly.

    Call me cynical, but I feel like the contexts where this could be powerful are far and few between. Professionals in the NDIS space often don’t have the time to unpack this sort of concept as thoughtfully as was done here.

    Where my concern begins to flare up, is I think that there is still a common view that the adults and adolescents we work with are “like children”, and “being like children” carries the implication of ineptitude and immaturity. It risks complicating the inherent carer/disabled person power imbalance with a child/adult power imbalance.

    I’ve seen these imbalances lead to consequences ranging from being overprotective to justifying violating someone’s rights because they need protecting. I’ve even come across PBS practitioners justifying a restrictive practice because it was in line with their “mental age” despite the guidance being that chronological age is our benchmark.

    Overall, I agree with the idea that using early interaction as a way of understanding an adult’s non-verbal communication is helpful. However, lacking the skill to deliver the concept in a responsible way I’ve found it’s helpful to remove the conversation of age as much as possible and try to highlight and unpack what why someone might respond in a certain way from an individualistic point of view.

  5. Language around any topic can be fraught with controversy. Using language and receiving (decoding language) is a complex task, and it requires knowledge and can take time and reflection. And yes, some people lack the necessary knowledge and some the time for the necessary reflection to use language well. Some people just don’t have the language they need.

    Where we don’t have the language to describer and talk about a situation, this can give rise to what is referred to as an epistemic injustice. We might experience something, but not having the language to talk about it deprives us of the opportunity to share the experience with others or act on that experience, to do something in response to or about that experience. Sometimes not having the words to discuss something means we don’t even recognise that something is there or is happening – to others or to ourselves.

    It seems to me that it is an epistemic injustice that we cannot, or at least have not, discussed the complexity of intellectual disability beyond the often misunderstood notions of IQ and related psychometric constructs; that we struggle (or often times fail to struggle where we should be making an effort) to develop an understanding of the interplay between constructs such as the biological nature of chronological development and its sociological partner of age appropriateness (born largely out of Normalization Theory) and how the dominance of ablest norms seek to elevate age appropriateness to the one and only way we can respectfully understand and interact with a person with intellectual disability. How many limitations have we placed on people’s lives with the justification “but that’s not age appropriate”? The human person is more complex than merely their chronological age, and respect for the human person demands more than simplistic age-appropriate explanations and interactions.

    To address this epistemic injustice, I would like to see more discussion about how we could explore concepts such as ‘developmentally appropriate’ explanations of the person and interaction with people with intellectual disability. If to be culturally sensitive and appropriate we need to recognise others’ customs and indeed learn to speak their language, surly we need to extend such respect and indeed effort in our interactions with people with intellectual disability. We need to meet with people where they are at, in the context of their lived experience.

    Where people’s cognitive development and their psycho-social understanding of the world around them is at odds with their chronological development, as painful as it might be where we are so bound (sometimes unconsciously so) by our ablest views of the world, we need to honour intellectual disability as part of the broad diversity of what it means to be human. Its OK to be blind, to be deaf, to be a paraplegic or a quadriplegic, and its OK to be intellectually disabled.

    We don’t question the need to make accommodations and adjustments so that people with disability generally can be included and participate in school, work or society. Why do we impose ablest, chronologically constructed understandings and circumstances on people with intellectual disability? Why can’t we make reasonable adjustments in our use of language, expectations, and interactions based not on ablest chronological age appropriate expectations, but rather on culturally sensitive and respectful developmentally appropriate understandings?

  6. This is such an interesting discussion, thanks for raising it Sheri, I raised this during our team meeting on Friday and it led to a lengthy discussion.

    I can reflect two times over the past month when families reflected on their child’s behaviour as being that of a younger child. This actually provided me with rich information about the person and led to a hearty discussion around developmental milestones, functions of behaviour, skill development opportunities and replacement behaviours. It assisted the family to re-evaluate the support that their child required to complete a task, reduced the expectations they had upon the child and was a really important discussion in reframing behaviour.

    Most of the families that we support would have seen children around them grow up, they have watched their own children, their nieces, and friends’ kids grow up, development of milestones is something that would have seen many children achieve and would create a reference point, for which to reflect their own child’s behaviour too and for them to communicate this to us.

    As a practitioner, I’d much rather hear that a person had taken initial steps to understand a person’s behaviour by explaining it as “it’s like a two-year-olds” than hear them refer to the person as being lazy, naughty and manipulative, which unfortunately we continue to hear far too often.

  7. Very thought provoking discussion and such good contributions. I think making age comparisons should not be ‘banned’ but carefully considered, explained and discussed which is what’s happening on this site. The important things is, of course, to understand each person and how to interact with them in ways that are most helpful to bring joy, inclusion and improve wellbeing–that for me demonstrates respect. I will think on!

  8. A adult who using skills that typically develop in the first years of life, is different than a a child using skills that typically develops within the first few years of life. Because of the years of repetition and life experience. There are times where I have said that this individual uses skills such as cause-and-effect problem-solving… emerging object permanence… tool-use, etc. and these skills are ones that develop in X age range. So comparing the skills to the age versus the person to the age, I don’t know if that’s received much better honestly. One thing I think helps in an explanation, is talking about horizontal development over vertical development. So for our late adolescent and adults we are expecting that they can continue to learn with the focus on skills built on the foundation of the developmental underpinnings that they have already firmly established. (Ex. They have cause-effect, can I think of ways to generalize that understanding to different environments with different materials to support autonomy or independence)

    1. I think this is a much more elegant and well expressed approach. I shall work to program that language into my brain. I will be speaking at a conference a few weeks. I was wondering if I could quote you on this? How have you found it’s reception by the person’s family and supports? Also how have other professionals received this approach: I have found a variation from those relieved and in agreement, some agreeing but feeling not permitted to speak so concretely, some never thought of using the analogy but immediately understanding, to those who will not do it, and those who are fiercely anti.

Leave a Comment

Your email address will not be published. Required fields are marked *