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Chapter 1
Adolescence and social interaction
The purpose and background of âImagine, Create, Belongâ
The purpose of the âImagine, Create, Belongâ programme is to facilitate an increased capacity of the young people aged 11â15 years (early to mid-adolescence) to understand and respond appropriately to social situations. Because of this increased social understanding, the young personâs world is more cohesive, with an increased shift to a more positive sense of self. âImagine, Create, Belongâ aims to support adolescents who are neuro-diverse. This includes young people with Attention Deficit Hyperactivity Disorder (ADHD), Post-Traumatic Stress Disorder (PTSD), Autism Spectrum Disorder (ASD), and learning and language problems who have social difficulties. âImagine, Create, Belongâ is underpinned by the theoretical foundations of cognitive developmental play theories â particularly pretend play development â and Vygotskyâs social constructionist view of development, as well as person-centred therapy based on the work of Carl Rogers and applied to younger people by Virginia Axline.
This approach came about through a serendipitous morning coffee chat between Sophie Goldingay and Karen Stagnitti at their work base university campus at Deakin University. Sophie had completed a doctorate working with young prisoners in New Zealand. She had noticed that often they seemed to have misunderstood the social circumstances of why they were now in prison. Some appeared to have difficulty imagining the impact of their actions on themselves or other people. This was very different to not caring about what happened â it was clear many cared very deeply. Rather, it was more that some could not imagine it until it was pointed out or they were having a victimâs impact statement read out at a criminal trial. Karen had been working in the area of pretend play and had developed several play assessments and a therapy approach for children with developmental issues called âLearn to Play Therapyâ. Together they pieced together the hypothesis that some of the young people Sophie had worked with in her social work practice and during her doctoral studies possibly had not developed complex pretend play as children and were struggling with concepts of theory of mind, and lacked the ability to anticipate the consequences of their actions and think in sequential ways. Sophie then brought together a research team to create and study an approach based on principles of pretend play and narrative development, developed by Karen, which was suitable for neuro-diverse young people. Belinda Dean and Narelle Robertson were part of the research team and were involved in two studies trialling an eight-session therapeutic intervention that became âImagine, Create, Belongâ. Donna Davidson and Eleanor Francis became aware of this approach and could see the possibilities of this programme for young people who attended special school because of their challenging social behaviours, intellectual capacities below an Intelligence Quota (IQ) of 70, and neuro-diversity. Donna and Eleanor have used âImagine, Create, Belongâ with this group of young people and found it to be associated with positive changes in a reduction of challenging behaviours and more social awareness. The adaptations of âImagine, Create, Belongâ made by Donna and Eleanor are in this manual.
This chapter outlines the theoretical underpinnings of âImagine, Create, Belongâ. Chapter 2 presents how to use this manual and the specific techniques for facilitators found to be effective within the programme and tied to the theoretical underpinnings. The remaining Chapters 3â 10 are practical and outline each of the eight sessions of âImagine, Create, Belongâ, with a chapter for each session. Chapter 11 provides ideas for further developing participantsâ involvement in more independent ways that do not require facilitators. Within each of these chapters, the adaptations of âImagine, Create, Belongâ for that session for adolescents with more challenging neuro-diversity are presented, after an explanation of the format and activities used within the research studies with adolescents from mainstream high schools who were neuro-diverse. For the adaptations for each session, two sessions are provided by Donna and Eleanor because they found, when working through the programme with adolescents with challenging neuro-diversity, greater repetition and explicit teaching of foundational concepts was required.
The importance of social belonging for young people
Adolescence is a period beginning around 12 years of age and continuing into the early 20s (Yasenik & Gardner, 2017). In Western culture, early to mid-adolescence is a time of increased social interaction outside of family, with interpersonal relationships becoming more important (Harter, 2012; Nippold et al., 2014) as the young person strives to separate themselves from parents and differentiate themselves as unique (Harter, 2012). This view of adolescence comes from Western derived stage theories posited by Anna Freud and Erik Erikson in the 1950s and fits Western understandings that the autonomous individual is the basic building block of society (Drewery & Bird, 2004) where the development of personal autonomy and individualism is important. Young people spend more time with peers as opposed to adult family members, navigating social relationships and telling stories about themselves (autobiographical narratives) to achieve a sense of belonging and emotional support (Nippold et al., 2014).
Experiences of young people at this age in cultures not derived from an individualist Western tradition are likely to differ from those cited above, however. For example, collectivist cultures may prioritise deepening connections and relatedness with kin during adolescence as opposed to separation from them. In New Zealand, Mason Durie (1998) notes for Maori that identity development is a collectivist process to deepen family connections across the generations, both past and present. In Australia, young people of Aboriginal and Torres Strait Island nations are also likely to experience the process of healthy growing to maturity differently. Identity for Aboriginal people comes with oral sharing of the history, stories of their bloodline that connect them to their traditional land, beliefs and values. Thus, identity, connection to culture, and community become of interest at this age but can also be challenging (Eccles 2019, personal communication). A research project in Melbourne, based on a partnership with a local Aboriginal Community Controlled organisation which included four senior Aboriginal women as project advisors (Priest, Mackean, Davis, Briggs, & Waters, 2012), found that strong culture was the central core of Aboriginal child health, well-being, and identity development. From interviews with Aboriginal grandparents, parents, aunties, or uncles of Aboriginal children, the researchers found this concept included âpassing of cultural knowledge from one generation to the next and modeling of community and gender-related rolesâ (Priest et al., 2012, p. 184). Thus, rather than aiming for separation and differentiation from parents or parental figures, the process of healthy identity development for Koori (e.g. those who are from Victoria and New South Wales, Australia) adolescents involves spending more time with elders and building connections through participation in community events and ceremony which involves the whole family. A deepening of spiritual connection to Country, with its associated custodian responsibilities, is also an essential part of identity development for Aboriginal and Torres Strait Islander adolescents. Development of storytelling and narrative ability is key to identity development in adolescents irrespective of cultural background, however.
Physically, adolescence is also a period of major brain re-organisation and pruning (Siegel & Bryson, 2012; Siegel, 2012, 2013), with the highest volume of grey matter in the brain occurring during early adolescence (Yasenik & Gardner, 2017, p. 74). The brainâs capacity to process emotions is âfully onlineâ but with control of emotional impulses still maturing (Yasenik & Gardner, 2017, p. 74). Prior to adolescence, the autobiographical memory of a 10-year-old young person is in their control as they become the owner of their own story, with the ability to evaluate what others think of them while becoming more concerned about what others think of them. In this pre-adolescent time, older children use social comparisons for assessments of their personal competence, alongside being able to describe themselves by characteristics (Harter, 2012). For some young people, adolescence sees a dramatic increase in social awareness and self-consciousness of othersâ opinions (particularly peers) of who they are (Harter, 2012). As noted for both Western and non-Western adolescents, significant adults are important during the period of mid-adolescence, as they support the young personâs autobiographical account of past, present, and future.
During early adolescence, young people are changing in their language and cognitive abilities. They are moving from concrete to formal operational thought, and this makes it possible for them âto engage in hypothetical-deductive reasoning, the ability to think logically and abstractly about complex issuesâ (Nippold et al., 2014, p. 878). Young adolescents may begin to show interest in discussion of social, political, or religious topics and, as they are very aware of hypocrisy in others, may do so from an idealistic perspective (Harter, 2012; Nippold et al., 2014). Changes in their cognitive capacities are shown in an increasing ability to take a socially oriented perspective, that is, what is good for society, more than a perspective primarily centred on the self (Nippold et al., 2014). They use longer sentences to express themselves with narratives that show more complex language structures (Nippold et al., 2014). Oral language competence, including narrative competence, underpins literacy achievements and contributes to academic achievement (Nicolopoulou, Barbosa de SĂĄ, Ilgaz, & Brockmeyer, 2010; Snow & Powell, 2011).
Neuro-diversity and social difficulties
Adolescence, then, is a time of major change for the young person â in brain development, sense of self, and cognitive and language capacities. For some adolescents who are neuro-diverse and who struggle with social situations, their experience may be more of loneliness and rejection which, in turn, increases anxiety levels and compounds their social difficulties (Parker & Asher, 1987). Young people who are neuro-diverse may have greater difficulty coping with complex social situations in adolescence and may find themselves isolated, which contributes to poorer well-being (Parker & Asher, 1987). Social difficulties have been related to lower oral language and narrative abilities. Snow and Powell (2011) found that young offenders had lower oral language ability than expected for age (which supports Sophie Goldingayâs observations during her practice experience and doctoral studies). Oral language also includes telling stories, and an ability to tell a narrative coherently has been reported as being difficult for children with autism (Stirling, Douglas, Leekam, & Carey, 2014). For young people aged 10â12 years with ASD and co-morbid ADHD symptoms, executive function difficulties were associated with ADHD symptoms, with associations between executive function and theory of mind impairments also providing insight into the functioning of these young people (Lukito et al., 2017). âImagine, Create, Belongâ was developed with these young people as the focus of this programme.
A different approach for neuro-diverse adolescents
Approaches such as Cognitive Behavioural Therapy through to social skill development and emotional insight may be ineffective for neuro-diverse young people due to problems with attention, language, and memory (Goldingay & Stagnitti, 2014). Approaches such as Cognitive Behavioural Therapy require insight and cognitive capacities with the linking of feelings and behaviours that many young neuro-diverse people struggle with (Attwood & Scarpa, 2013). In adolescence, many young people who are neuro-diverse have experienced developmental difficulties as they have grown up, such as: reduced ability to read social situations; lack of understanding of social contexts; poorer ability to negotiate with peers; lack of narrative ability, including difficulty extending a story, identifying and resolving problems in the story, poorer understanding of charactersâ emotions, actions, and what they would say; and following conversations (related to logical sequential thought processes). These difficulties are also present in children with poor pretend play ability (Stagnitti, 2016a; Stagnitti & Unsworth, 2000). Goldingay et al. (2015) found that neuro-diverse young people show deficits in pretend play ability, particularly the link between creating a story (narrative) and play. Studies have found that embodiment of the story in role play (âembodimentâ, also being called âembodied cognitionâ, that is, the whole body is moved to act out the story) is more effective for recall of the story than just using a puppet, play props, or pictures (Lillard et al., 2013). This shows that the deeper the physical and emotional engagement in the play, the more likely the child is to engage in a cohesive narrative, thus developing this ability for use later in life. In addition, Gray (2011) found a correlation between increased play in childhood and decreased anxiety and depression in adolescence.
An age-appropriate play-based approach, then, offers an alternative to working with adolescents who are neuro-diverse and who experience difficulties in social settings. Many young people with developmental difficulties have not developed foundational skills through early play behaviour and during early play behaviour were often not involved in group play to a complex level of playing a scenario over several days or weeks with peers. Hence, while some young people who are neuro-diverse with ASD can engage in pretend play (Chaudry & Dissanayake, 2016), the complexity and length of playing may not match that of their peers. Thus, skills, such as awareness of the thoughts and mental states of others (theory of mind) and ability to think in sequential ways for developing and understanding a cohesive narrative that evolves in the play, may not be developed.
Theoretical underpinnings of âImagine, Create, Belongâ
Several theoretical approaches influenced the development and design of âImagine, Create, Belongâ. This section explains these approaches, starting with early pretend play development and links to social competence, narrative, theory of mind, and repres...
