Mareschal et al. (Reference Mareschal, Johnson, Sirois, Spratling, Thomas and Westermann2007a) consider two fundamental aims in the study of developmental disorders: “to identify appropriate methods of remediation” and “to use disorders to help our understanding of the normal processes of development” (p. 160). The authors broadly develop this second aim, showing that atypical development permits the study of developmental processes in situations with different constraints (even if assumptions must be cautious because atypical development is not necessarily a window to normal development: Karmiloff-Smith Reference Karmiloff-Smith1998b). However, they do not extend their first aim. We understand their work does not have a clinical orientation, but we consider the development of the implications of neuroconstructivism fundamental for the implementation of intervention programs aimed at improving psychological functioning in people with cognitive difficulties. Only by tracing the atypical trajectory of a process from the beginning is it possible to try and remediate cognitive deficits by emphasizing developmental strengths from as early as possible (even before behavioral deficits are evident).
Frequently, intervention is solely based on behavioral measures, without considering the possibility that a similar behavior may rely on different processes. In some cases, discovering these underlying processes should be the main objective of remediation because the generalization and adaptability of behavior may only be guaranteed if we use them as the basis for intervention. In our opinion neuroconstructivism's radical rejection of Marr's levels could be extended to the need to consider more than just the behavioral level in the design, implementation and evaluation of intervention programs.
In addition, neuroconstructivism's opposition to the maturational and modular approaches of development can be argued not only from its theoretical consequences, but also from its effect on clinical decisions, specifically on the futility of intervening in those domains that are considered preserved. For instance, Williams syndrome (WS)'s uneven cognitive profile may seem to support modular perspectives that describe preserved linguistic and social abilities and therefore, from these approaches, intervention in these domains is considered unnecessary. However, evidence has shown that language and social understanding abilities are far from intact in WS (Karmiloff-Smith et al.Reference Karmiloff-Smith, Grant, Berthoud, Davies, Howlin and Udwin1997; Sotillo et al. Reference Sotillo, García Nogales and Campos2007). Since diagnosis is obtained early on, it is essential to intervene in these and other areas as soon as possible.
In developmental disorders, atypical functioning of ontogenetic processes is expected. Mareschal et al. establish two driving forces in development: proactivity and progressive specialization. However, they say progressive specialization “does not seem to be the whole story” (p. 213; emphasis ours) because representations also go through a process of progressive abstraction. The “tension” authors find between the processes of specialization and explicitation is evident, but it is still necessary to explain their coherence, both within and between different functions.
One possibility is that each process has a different influence on diverse cognitive functions. Rivière (Reference Rivière, Belinchón, Rosa, Sotillo and Marichalar2003) proposes a Vygotskian based taxonomy of four initially hierarchical and cumulative psychological functions: F1 or modular unspecific (e.g., brightness perception), F2 or constructive nonsocial unspecific (e.g., object permanence), F3 or rudimentary-higher (e.g., language) and F4 or proper-high-functions (e.g., multiplication). Set on a continuum, F1 would be highly modular, associated with a precise neural localization, inflexible, and very efficient; while F4 would depend completely on culture and require explicit instruction. Development of F1 and F2 would lean fundamentally on specialization processes beginning as automatic in F1, and progressively becoming more dependent on experience in F2 and F3 (already being specifically human and dependant on social interaction). Development of each psychological function would rest differently on each developmental process, although both are necessary; and their coherence is particularly relevant in cognitive functions that imply redescription but also permit progressive specialization.
Representations specialize by getting more efficient and context dependent. However, context sometimes does not offer sufficient clues. It is not stable, and therefore explicit representations are also necessary for a systematic and compositional cognition. Implicit, embodied representations remain available when automatic, efficient functioning is required, but explicit representations permit independence from context, conscious reasoning and interrepresentational relations (Karmiloff-Smith Reference Karmiloff-Smith1992). Abstraction will be greater in higher functions, which require social interaction in such a way that explicitation needs not only internally but also externally generated social activity. F3 (as theory of mind –ToM) are just in the vertex of biology and culture, and allow approaching the role of ensocialment, embrainment, and embodiment in typical and atypical development.
People with WS are truly motivated to maintain social relationships and are rather capable of recognizing emotions. Nevertheless, from the assumption of an atypical developmental trajectory from the beginning at multiple levels, it does not seem viable to describe a preserved ToM module, or even submodule (Tager-Flusberg & Sullivan Reference Tager-Flusberg and Sullivan2000). Instead an atypical trajectory in developmental processes is predictable.
The influence of specialization and explicitation on the development of ToM abilities in WS children has been analyzed in our lab (Campos, in preparation), and the results showed a lower performance in ToM than expected from their mental age. Furthermore, development of explicitation competences of mental states appeared particularly delayed in this group. Consistent with Karmiloff-Smith's (Reference Karmiloff-Smith, Munakata and Johnson2006) predictions for atypical development, the processes of specialization and explicitation seem affected in WS in the social domain.
Research results are essential for intervention. If implicit processing abilities are better in WS, it is then possible to use an implicit approach in a clinical setting. Diverse developmental trajectories should imply different ways of remediation. Intervention with people with autism usually implies teaching some F3 as if they were F4, by explicit instruction (Howlin et al. Reference Howlin, Baron-Cohen and Hadwin1999). However, in WS it could be more efficient to intervene based on their strong points: intersubjetivity and empathy, and to use their genuine interest to establish social relationships to provide them with social strategies for understanding mental states.
The neuroconstructivist perspective has an interesting potential, and we consider it crucial to extend its implications to clinical intervention, in order to improve the quality of life for people with developmental disorders. Research on optimal clinical strategies in different developmental situations will also have theoretical implications for the study of ontogenetic mechanisms. To achieve this, Rivière's taxonomy of functions could be a useful tool in that proactivity and progressive specialization would not need to be “the whole story,” as they both would play their own part in every psychological function.
