Autism & Aspergers syndrome
APPENDIX
Autism and Aspergers syndrome
Researcher (Hermine Posch) University of Graz Austria
A U T I S M / A S P E R S E R S
|
Pervasive Developmental (Autism Spectrum) Disorders (American Psychiatric Association 1994, in: Cumine et al. 2000)
|
RESEARCH
Psychology / Sociology:
The nature of Autism has been subject of early investigations (e.g. Kanner 1943;
Wing and Gould 1979) and was characterised by
- Impairment of social interaction
- Impairment of social communication
- Impairment of social imagination, flexible thinking and imaginative play
Genetics:
A team of the university of North Carolina assumes that 90 % of autism is caused
by genetical factors, very likely by chromosom 13 but there may be more than one
gen involved, e.g. a region of chromosom 7 (American Journal of Medical Genetics,
Dec. 1999). However, more research is needed and a diagnosis today requires still
an observation by specialists over a longer period of time to come up with a good
diagnosis.
Biology and physiology:
Rutter (1978) emphasised the involvement of organic brain dysfunction. One quarter
of his sample of children with autism developed epilepsy in adolescence. Olsson
et at. (1988) also found a high incidence of epilepsy in a sample of children with
autism, and Steffenburg and Gillberg (1990) found that around 90 per cent of their
sample of 35 children with autism showed evidence of brain damage or dysfunction.
Beck (1999) critizises that the overwhelming biological and physiological problems of autistic children are not given enough attention in many traditional profiles of autism. They would focus mainly on abnormal social development and behaviour. Biological and physiological problems can include:
- Gluten/casein intolerance
- High viral antibody levels
- Gross deficiencies in vitamins and minerals (in particular Vitamin A and zinc, magnesium, B vitamins, antioxidants)
- Abnormal EEGs and seizure activity
- Abnormal thyrioid levels
- Intractable diarrhoea and other gastrointestinal problems, causing malabsorption of nutrients and toxin build-up
- Frequent ear infections
- Food intolerances
- Myelin Basic Protein antibodies
- Compromised immune response
- Excessive levels of toxic agents such as cadmium, lead, aluminium, mercury and other environmental toxins
- Abnormal urinary peptides
- Essential fatty acid Imbalances
- Excessive, thirst and fluid consumption
Biochemical approach:
Danczak (2000) emphasises the biochemical approach based on research on immunology.
According to him food allergy is not important and only a symptom of an unstable
immune system that needs to be worked on. This chemistry-based therapy needs to
be supplemented by a behavioural program.
Rimland (1992) states that there is no typical autistic child just as there is no typical reader of a book. Williams (1992) confirms the complexity that may exist in the overall "autistic picture" and reports that many (not all) of her symptoms were traceable to certain food allergies, and that her brain reacted badly when its vitamin supply was insufficient. Some childrens' behaviour has improved when cow's milk, wheat, eggs, or other common foods were removed from their diet. Almost half of all autistic children and adults need larger amounts of vitamin B6 and the mineral magnesium than do nonautistic persons. Thus Rimland concludes that part of the problem of autism is obviously biochemical.
ASSESSMENT AND DIAGNOSIS
For parents, diagnosis can end years of bewilderment, self-blame, distress and frustration. The basis for diagnosis currently is Wing's Triad of Impairments; the full diagnostic criteria can be found in ICD 10 (WHO 1992) and DSM IV (APA 1994). However, there is no simple test or checklist which will confirm the diagnosis of autism. Adequate assessment and diagnosis of autism will involve a range of professionals from various disciplines (a list can be found in Cumine et al. 2000).
CURRENT THEORIES FOR INTERVENTION
Despite extensive research into the biological nature of autism and its genetic bases, it is still not possible to pinpoint with certainty the area or areas of damage in the autistic brain, much less the pathway from the brain to the behaviours. During the last decade some theories have emerged dealing with the developing mind of the young child with autism. Cumine et al. (2000) provide a good overview of current theories and a summary as follows:
- The impairment revealed in theory of mind investigations highlight the difficulty people with autism have in understanding others' mental states.
- Intersubjectivity theories emphasise the difficulties with emotional understanding and underline the importance of emotional involvement in learning.
- The central coherence deficit theory indicates the importance of ensuring the appropriate focus of attention and catering for a particular learning style.
- Suggested difficulties in developing an 'experiencing self' indicate the need for teaching approaches designed to enhance self-awareness and personal memory.
- Theories of executive function deficit confirm the necessity for structure and clarity in teaching approaches.
Jordan (1999) points out that different theoretical understandings can nevertheless result in similar teaching approaches.
INVOLVING THERAPY (used in Austria successfully)
The program used by Muchitsch in Austria can probably be summarised with the following poetic words:
I am entering your world
and become one part of it
and I will be leading you
step by step
into our world
then we will have
one part of the world in common.
At first autistic children were observed in their behaviour. Muchitsch found three types of stereotypes on three different levels of development partly comparable to the development of an average child. These stereotypes she interpreted as games of autistic children. To change anything she knew she would have to become part of their games, she would need to be involved in their world. Step by step she managed to move the autistic children closer to her world and always with giving them the opportunity to take their world with them, which means respecting their way of being. The main approach of Muchitsch' therapy was to refer to stereotypes related to objects the individual liked. (comp. Fischer 2000, Wohlleben 2000) These stereotypes show already some kind of interaction with the environment (in contrast to stereotypes related to the subject such as watching his/her own fingers etc.). Children are able to connect perception and action when showing stereotype behaviour related to objects. To forbid this stereotype behaviour would therefore mean to eliminate the next step of development.
After a long time of observing autistic children and developing ideas the following concept was set up by Muchitsch:
- Working with the child individually: A training for
parents and children involves to build up wanted behaviour and to reduce the
unwanted. The parents are carefully trained before they start the program
which is set up in six steps (5 to 15 meetings with the therapist once a
week):
- watching the parent-child-interaction
- analysing the behaviour patterns of the child (baseline).
- introducing general learning rules to the parents.
- Model learning: Parents watch the child-therapist-behaviour pattern.
- Parents are involved in the therapy step by step; they learn various necessary strategies and have the opportunity to practice.
- Parents act independently in the training session and at home. The therapist is now a supervisor.
- This training program did not show much success when it was followed once a week only but it was successful when continued daily at home. A study with 12 low functioning autistic children showed positive results by using a systematic training based on strategies of behaviour therapy. Favourite food did not work as a positive stimulus over a longer period of time but the child's favourite stereotype play was used successfully in the therapy.
- Moving on to an institution (day care centre/school)
After individual training at home all of the 12 children could be passed on to institutions for further education. However, soon after the change of place signs of regression showed up, which was recognised as a transfer problem. This could be solved by involving the teachers for children with special needs in the program of the autistic children. They were then able in the beginning to continue the program the children were used to. The same transfer problem occurred when the autistic children were passed on to school. As soon as the teachers did not follow the training program in their pedagogical strategies the autistic children stopped to cooperate. In addition, it was necessary to develop a new method for reading, spelling, calculating and motor skills because children with autism have problems coping with complex situations.In a project there are classes with 10 children and two teachers with autistic and non autistic children working together. Autistic children get additional special training daily. It is possible to teach these children the first school year in the institution in order to prepare them better for school (e.g. work independently).
Individual special programs are supervised by a psychologist or a trainer for children with special needs and taught to the parents.
They include:
- building up of social behaviour (e.g. eye-contact, reduction of self-aggression, imitation exercises...)
- building up non-verbal discrimination exercises (e.g. visual and auditive perception exercises, fixation of objects...)
- developing language (e.g. passive vocabulary, phonetic exercises...)
- memory exercises (e.g. motor skills, concentration, exercises for daily life...)
Programs for groups include:
- musical education (rhythm) for the development of consciousness of the body, combination of auditive, visual and tactile perception, development of space and time and social interactions
- pedagogical programs for behaviour (compensation of deficiencies in motor skills, perception, language and social behaviour).
AUTISM AND TEACHING (Powell 2001)
One possibility to establish an effective relationship between teaching, learning and autism, is a "bottom-up" approach. It will provide some ideas from experienced people working with autistic individuals (various degrees of impairment) who especially benefitted from them.
1. Teacher/learner Relationship
Nind (2001) points out that in autism the boundaries between what is to teach
and what is to learn break down. The teacher and the child have to learn how to
be effective in their interaction and learning with each other. We may even
compare this interaction with a dance where "both partners need to learn to move
together if synchrony is to be achieved" (Powell 2001) The teacher must be able
to follow the child as well as to lead. (Prevezer 2001, Longhorn 2001) For
example, try to find out a child's likes and desires before you show certain
cookery skills etc.
Once a teacher found out what a child likes for some autistic children it may be a good way to learn if they can be the teacher of their teacher (the child has to focus on the understanding of a certain task). Once successful, the child may even go on to teach a peer. However, the child may not like to repeat what has been said before anyway.
2. Social and asocial learning
Do we need a certain environment for autistic children? Reduction in personal
communication and emphasis on heavily structured, concrete learning tasks would
point towards establishing a non-social environment. Autistic children may learn
best when the social dimension is reduced to a necessary minimum. Autistic
children have problems to recognise emotional signals and to react adequately to
them. This seems to be part of the autistic symptoms from the beginning on.
(Bormann-Kischkel 1990) Tjus and Heimann (2001) suggest the use of a
computer-generated set of activities as the context for social interaction
between pupil and teacher.
3. Newson (2001) sees the use of humour as an important factor to get children interested in communication. She mainly speaks about children who are able to use language to some extend (see also Aspergers).
Example for metaphor:
Phrases such as "I could eat a horse!" or "It's raining cats and dogs!" may
frighten some children (they may tend to take the sentence literally) but can
also cause a giggle. If a child is able to build on such language, flexibility
for language can develop.
Example for visual correspondences:
For some children it may be helpful to paint in order to control their outbursts.
They may be led to the notion that one can conceptualise the smell of a day, the
colour of a piece of music, the sound of an abstract shape or various kinds of
moods.
Examples working against inflexible thinking:
Newson discusses quite a number of games that may be used for some children as
they emphasise the idea of pretending: 'Let's suppose that...', 'The
other-way-round-world', 'What if things were different...', 'Living dangerously,
breaking conventions', 'What's silly about...?', 'On camera: make a speech, grab a
persona'.
4. Using the concrete, visual and spatial
In a pedagogy for autism a picture may be worth a thousand words though this way
of teaching may be harder and probably less flexible than a spoken word. The
possibility of clear visual identification shall be offered, e.g. finding a way
to record the passing time by using a digital watch where the numbers are easier
to identify than on an analogue watch. (Peeters 2001, Powell 2001).
5. Learning to 'tune in' to the pupil with autism
The moments when pupil and teacher are 'in tune' may be sometimes rare. But when
such moments appear the teacher should be able to use them effectively.
Sensitivity to the child's way of thinking and feeling as well as to the parents'
situation is needed. (Muchitsch 1990, Newson 2001, Prevezer 2001, Procter 2001)
Musical Interaction can provide contexts which are familiar and motivating,
helping a child and adult to make sense of each other so that new information
and ideas can be more easily learned and understood. (Prevezer 2001)
6. The potential of mutuality
The individual of autism needs to be shown not just that information can be
learned but also that it can be shared. Moments of 'give and take' are for the
teacher and for the learner very important to experience and may motivate both.
This understanding can be developed if the teaching and learning situations are
carefully analysed before. (comp. Muchitsch 1990, Nind 2001, Prevezer 2001,
Procter 2001)
7. Progress from self-regulation to independent thinking
Organising the physical environment can help children to develop independency
and self-esteem. This may be achieved by the rhythm of music, the 'dance' of
social interaction, the redesigning of a joke, the organisation of the room or
in other contexts. (Powell 2001)
8. Learning by using senses
Especially in autism we need to recognise that effective learning may take place
through all five senses, which should not be underestimated. This pedagogical
strategy may also be used for many other children (e.g. especially for dyslexic
children). Prevezer (2001), for instance, combines her work with sounds, physical
movement and contact as well as with visual messages. (see also Longhorn 2001)
9. Evaluation
Continuous evaluation of the teaching and learning process is important to a
teacher's effectiveness. Procter (2001, Nind 2001) claims that actions and
reactions of all persons involved need to be analysed. The evaluation needs to
look at the specific characteristics of autistic children in order to be useful
(e.g. a teacher's utterance may trigger a child's memory; the associated word
shall be noted and positively marked).
10. Teaching versus learning
In autism some things may not be teachable - yet it would not necessarily mean
that the same things may not be learnable by the individual with autism. I may
learn to love someone or something but this does not mean that I can teach someone
else to love in these ways. A child may have other kinds of problem solving than
the idea a teacher has. For teachers it is important to think about how to
organise a useful context for learning because it may be the case that those
with autism can learn but may not be receptive to being taught. (Nind 2001) For
autistic learners it is also helpful when teachers make themselves predictable
in their behaviour because the demands on the individual pupil are reduced (e.g.
by using music, responsive body movements, etc.). (Prevezer 2001, Nind 2001) An
autistic child may throw a tantrum when getting a surprise present but it may be
able to enjoy it when carefully instructed about the present ahead (e.g. when it
will arrive). For effective learning children with autism need a predictable and
ordered environment.
11. Learning about learning
Autistic children may not realise that what they are learning is relevant for
them. As their way of learning is kind of disconnected they need to be shown the
connections. They will need visual structure (e.g. picture cards, photographs,
video) for supporting their understanding between what they learn and what they
do. Micro-teaching may be useful as the learning event can be shown on video;
children see themselves on action and may discover the significance of learning
for them. (Powell 2001)
12. Teaching towards increased independence
One of the highest pedagogical aims is to lead autistic children to as much
independency as possible. Some of them may really manage to live an independent
life (Muchitsch 1990) whereas others still need support throughout their lives
and live in some kind of community.
OTHER INTERVENTION APPROACHES
Many different approaches have been found to be effective in improving the ability of individual children to make sense of the world in which they live. However, no single approach has yet been found which is effective with all children with autism and no approach can be seen as a cure. Most of the following approaches are described in more detail in Cumine et al. 2000 (including evaluation:
PECS = Picture Exchange Communication System;
Pyramid Educational Products, the source for products designed to enhance the
lives of children and adults with autism and related developmental disabilities.
The program shall increase the child's desire to communicate and provide the
language with which to communicate.
http://www.pecs.com
e-mail: earlybird@dial.pipex.com
TEACCH-Program (developed in Japan) - Treatment and Education of Autistic and
related Communication handicapped Children
Significant improvement in appropriate behaviour and communication are the main
reported benefits.
Address: Division TEACCH, CB#7180, Medical School Wing E, University of North
Carolina, Chapel Hill, NC 27599.
INTENSIVE INTERACTION - further information: Melanine Nind, Open University at Milton Keynes.
APPLIED BEHAVIOURAL ANALYSIS (LOVAAS) - especially parents of young children
report significant improvements in their child's ability to access the world.
http://www.peach.org.uk/Home/
e-mail: peach@brunel.ac.uk
SON-RISE PROGRAM (OPTION APPROACH) - parents change their views and grow in their
confidence when being with their child; the quality and quantity of the child's
social responsiveness improves.
e-mail: startup@option.org
DAILY LIFE THERAPY (HIGASHI) - this holistic approach aims at reducing the
child's autism by developing close bonds in the family, with the teachers and
between the children in the group who are kept together. High level of physical
exercise is beneficial to all children with autism. Parents report great
improvement in self-help skills such as toileting and feeding including a wider
tolerance of foods.
Address: Robert A. Fantaswia, Principal Director of Special Education, 800 North
Main Street, Rudolph, Moss., 02368, USA.
AUDITORY INTEGRATION TRAINING (AIT) - developed by two French physicians, Alfred
Tomatis and Guy Berard. Electronically filtered music is being played to the
patient via headphones. This should help to correct hearing distortions and other
factors such as dyslexia, attention deficit, hyperactivity, depression and autism.
Many parents mention the high costs. Some report increased calmness, reduced
aggression and a sharp reduction in problem behaviours, while others report
increased hyperactivity and increased tantrums.
Address: Auditory Integration Training, The light and Sound Therapy Centre, 90
Queen Elizabeth's Walk, London N16 5UQ.
Phone: 020 8880 1269.
Rosenkotter (2000) states that in some cases anatomical and electrophysiological investigations show a dysfunction of various areas of the brain stem, which results in a central hyperacusis. The symptoms (e.g. covering ears, avoiding noisy areas) are for example present in children with speech disorders, autism, hereditary auditory hypersensitivity. Hearing training (AIT) has proved to be effective in the therapy of hyperacusis. The therapy works with desensibilisation by using a so-called "Lateral CD" (filtration of high frequencies; classical music; sound moves via headphones in a slower rhythm from one ear to the other) for 20 to 45 minutes per day over a period of two to three months. Hearing ability, phonematic attention and sound discrimination are expected to improve. The therapy can be done at home provided the equipment is available (CD player, headphones, lateral trainer and high frequency trainer need to be connected). The therapy effect may decrease within 6 to 12 months; then the therapy is repeated. More research is needed. The therapy does not replace additional treatments that may be necessary (e.g. behaviour problems, language therapy etc.).
DIET (OPIOID EXCESS THEORY) - not all people with autism benefit from the diet; it seems that younger, more seriously afflicted children respond better (Shattock 1990).
SECRETIN - Children are given a series of injections of secretin to overcome
digestive problems and increase skills (e.g. language). Not all children who have
tried secretin have shown increase in skills as some other reported.
Address: The Autism Research Unit, The School of Health Sciences, University of
Sunderland, Sunderland SR2 7EE.
Phone: 0191510 8922
IRLEN - Some people with autism have severe visual processing problems, and sight may be their most unreliable sense. Vision may completely shut down at times and cause visual tuneouts and whiteouts (to see snow as if they were tuned to a TV channel). Other autistic people with normal vision may have depth perception problems and difficulties going down stairs. The eyes and the retina usually function normally; the problem arises in processing visual information in the brain. This can result in a variety of symptoms such as problems with face recognition NieB 2000), with fluorescent lighting (Grandin 1995, Williams 1999a, 1999b) and others. Some receive more reliable information when they look out of the corners of their eyes.
Various people working with autistic children have reported successful use of
coloured glasses (lrlen glasses) with some of them. They did not cure autism but
made a big difference in the visual perception. The colour appears to change the
rate at which the brain processes information. Improvement has been reported in
the areas of the integration of sense perceptions, ability to respond, body and
spatial awareness, eye contact, communication and self-control. Most of the
wearers felt more grounded and centred, better able to participate in spontaneous
conversation. (compare Williams 1999b). An experienced diagnostician is necessary
and even in that case problems such as refusing glasses (tactile sensitivity) may
occur.
Address: Ann Wright, Irlen Centre East, 4 Park Form Business Centre, Fornham
Street, Genevieve, Bury St Edmunds, Suffolk IP28 6EX.
Phone: 01284724301
There are more programs to be mentioned such as the DELAWARE AUTISTIC PROGRAM, the LEAP-PROGRAMM (Pennsylvania) or the LINWOOD-METHOD (Maryland). Cumine et al. (2000) report that an approach which combines elements from a number of different approaches and accounts for individual differences is likely to be the most effective intervention.
Books:
http://www.exceptionalresources.com
PARENTS
Though many things about autism are still unclear a load of guilt has been taken away since we do know that autism is not caused by bad parenting (Bettelheim 1967), but rather is the result of some abnormality of brain development occurring for a variety of reasons either before birth or early in childhood. (Bartak 1992, Rollett 1995)
Parents have to cope with their baby who may stiffen up and resist being held or cuddled, who may be extremely sensitive to touch and respond by screaming. Later symptoms of classic autism may be observed: no speech, poor eye contact, tantrums, appearance of deafness, no interest in people, and constant staring off into space. (Grandin 1995)
All parents are happy about the development of their children, but for parents of autistic children every little step in development is a special highlight. (Kaufman 1979, Aarons/Gittens 1994) Parents may need to inquire a range of specialists in order to find the most effective treatment for their child. Beck (1999) encourages parents to identify specific health problems of their child, categorise them and write them down. She offers a list of support:
How to identify health problems of your child before consulting specialists (Beck 1999)
| Select the categories that may apply | Identify the physical symptoms your child or family history has | Identify the best specialists in applicable categories with phone numbers |
| Gastrointestinal | Diarrhoea Loose stools Constipation Vomiting Reactions to certain foods |
|
| Endocrine | Low basal body temperature Excessive thirst Skin problems Excessive sweating Family history of thyroid problems |
|
| Neurological | Abnormal 'staring' behaviour Tremors 'Zooned out' |
|
| Nutritional | Propensity for certain foods Vitamin deficiencies Poor teeth |
|
| Immunological | Problems occur after vaccine History of frequent ear infections Allergies Rashes Red cheeks |
Often it may be difficult to accept the child's behaviour because a child with autism tends to like whet he/she likes no matter what others think about it, no matter of social acceptability. The problems that arise for parents are very different and even the same behaviour that may be a problem for one family is not of importance for another family. Thus, it is best to develop an individual plan with all those involved in a program for the child (psychologist, helpers, trainers, teachers). Nevertheless a few main points shall be made on characteristic behaviour of the autistic.
Autistic people need to know where they stand in terms of relationships. They need to have reassurance of someone's love. It is helpful if parents keep their voice soft and even; shouting may be interpreted as not being loved any more. Autistic children can be quite territorial, some cannot bear the thought of anybody coming in. This interrupts their daily routine and can make them upset. As their boundaries extend outward from the immediate body they can become quite angry if a quest touches or moves any objects without having asked politely before. On the other hand autistic children are very curious and may open other people's bags and begin peering through them. They have difficulty guessing the feelings or thoughts of others. The best strategy is to prepare an autistic person before the intended change occurs. (Grandin, 1995, Lawson 1998, 0'Neill 1999, Lawson 1998) No doubt, life with an autistic child causes stress. The list of issues that can cause stress is endless. One suggestion how to manage stress is found in Beck (1999).
Six stress savers
(Beck 1999)
- Expectations of others
I will recognise that the expectations I have of other people can be a huge source of my own little stresses. I should try to manage those expectations, because in doing so, I will eliminate much of my stress. - Expectations of Self
The expectations I have of myself need to be appropriate, given my circumstances. - Organisation / Time Management
My organisation and time management skills are central to keeping a focused mind and to minimising the stress that disorganisation and wasted time can ultimately cause. - Targeting Actions
I should target my actions in ways that will foster goodness within me and promote progress for my child. - Managing Feelings and Emotions
I will not deny my feelings and emotions, but I will strive to manage them and share them with the right people, to the right degree, for the right purpose, in the right way. - Nurturing Important Relationships
I will nurture only personal and professional relationships that serve a positive purpose in my life and the life of my family.
Parents may not have advanced degrees, and not even have undergraduate degrees. But they do have initials after their names that have probably never been noted: I.M., meaning my child's mom (or dad), I.M. able to see things every day that are clues to my child's illness that no one else has the opportunity to capture. I.M. motivated, dedicated and activated in a way that only someone living with autism each and every day can possibly understand I.M. worthy of respect and consideration as any other specialist or professional (provided I am educated, reasonable and rational about the subject at issue).
Parents usually know the life style that fits best for their children. Depending on the child's ability they shall start with constructive considerations and support of specialists about their child's future in time (appr. at the age of thirteen or fourteen). An autistic person may have developed as for as to manage independent life and work, others may need personal care throughout their lives and live in organised communities. Autism is a lifelong condition and early identification and intervention will enhance opportunities for building on strengths, avoiding secondary behaviour effects and offering strategies for coping - ultimately protecting the individual's lifelong needs. (Cumine et al. 2000).
AUTISTIC ADULTS
Throughout history, autistics have been denied human rights to dignity. They are often victims of oppression and discriminated against in the some manner as people of various colours or religions are discriminated against. Autistic people are innately separate and different. They live their own lives in an interesting, unusual fashion. (O'Neil 1999, Grandin 1996)
Very often autistic people are simply not aware of the needs of others. They have a different outlook and perception; they can be amazingly tolerant. When they can stand up for themselves (develop their own voices and a mode of communication) they can surprise others positively. Autistic people understand the feeling of being oppressed.
There are autistics who enjoy being autistic. Grandin (1995) for instance says,
"I think in pictures. Words are like a second language to me. I translate both spoken and written words into full-colour movies, complete with sound, which run like a VCR tape in my head When somebody speaks to me, his words are instantly translated into pictures. Language-based thinkers often find this phenomenon difficult to understand, but in my job as an equipment designer for the livestock industry, visual thinking is a tremendous advantage."
In this case it seems that the visual system has expanded to make up for verbal and sequencing deficits.
There are also those who don't enjoy being autistic. They should not be compared with one another. Autistic people seem to like to learn about one another. Most of them lead extremely limited lives, in part because they cannot handle any deviations from their routine. (O'Neil 1999, Grandin 1995)
Persistent perception and communication problems can cause problems at work. Some autistic people show self-destroying and/or aggressive behaviour when feeling disturbed by noise, light, crowds of people, narrow rooms, too high or too low temperature in the room, stress and time pressure, not predictable changes and change of colleagues. It may be difficult for them to start work and to be flexible. Autistic people, however, can be very talented (e.g. good memory, visual abilities). Under good conditions they can concentrate very well and work precisely. They may work in the production, in libraries, supermarkets, petrol stations, hospitals, forms, laboratories, as architects, programrs, etc. An integration plon of all people involved at work should be developed with the support of specialists. (Dalferth 2000, MaaB 2000)
Aspergers syndrome,
This syndrome derived its name from an Austrian - Hens Asperger (1906-1980) a doctor, who lived and worked in Vienna.
ASSESSMENT AND DIAGNOSES
Today two major diagnostic instruments are used by clinicians: the Diagnostic and Statistical Manual (DSM IV, American Psychiatric Association 1994) and the International Classification of Diseases, 10th ed. (ICD 10, World Health Organisation 1992). Both systems rule out language delay, and do not include motor coordination difficulties or organisational problems.
In 1992, for the first time, ICD 10 gave diagnostic criteria for Asperger syndrome separately from autism. These criteria define Asperger syndrome as similar to autism, but without the language and cognitive impairments. Cumine et al. (2001) provides a good overview of diagnostic and assessment tools for the use within the autism spectrum. However, the debate continues as to whether Asperger syndrome should be regarded as part of the autism spectrum or separate from it. (Cumine et al. 2001)
Asperger syndrome can only be inferred from the interpretation of a pattern of behaviours, which needs a sound background of clinical knowledge. (comp. Frith 1989, Cumine et al. 2000). Digby Tantam (1997), a psychiatrist, describes people with Asperger syndrome as 'more individual than individual'. The 'boundaries' of Asperger syndrome overlap other conditions (e.g. ordinary insensitivity, emotional disorder, dyspraxia language disorder, Attention Deficit Hyperactivity Disorder, other psychiatric disorders); a range of professionals from various disciplines are needed to come up with an adequate assessment and diagnosis of Asperger syndrome. Assessment should be carried out over a period of time, since behaviour can vary from day to day as well as in different settings and with different people.
Teachers and educational support staff can provide important information supporting the assessment process. They may focus on social interaction, social communication, social imagination and flexible thinking.
| ASPERGER syndrome (Cumine et of. 2001) | |||
| Social Interaction | Social Communication | Social imagination; flexibility of thought | Motor clumsiness |
| Isolated but not worried about it | Lang. Perfect but formal, pedant | All-absorbing interest | Awkward movements |
| Tension, distress; trying to cope | Voice - lack of impression; tones of other voices | Certain routines | Organisational problems |
| Lack of strategies to make friends | Probl. with interpreting body language | Limited in thinking and flexibility | Hard to write and draw neatly |
| Difficult to pick up on social cues | Understands others literally | Probl. in transferring skills | Unfinished tasks |
| Behave in a socially inappropriate way | Fails to grasp implied meanings | ||
Before planning educational intervention for the child with Asperger syndrome, we must understand the child's way of thinking, as current psychological theories (comp. Jordan and Powell 1995, Frith 1989, Goldman-Rakic 1987) found out that these children have impairments in:
- 'Theory of Mind' (e.g. difficulty in understanding their own behaviour, emotions and those of others);
- Central Coherence (e.g. insistence on sameness and routine, attention to detail, obsessional preoccupations, existence of special skills); and
- Executive Function (e.g. difficulty in planning, self-monitoring, giving correct responses, in starting and stopping).
ASPERGER syndrome AND TEACHING
No two children are affected in exactly the same way, thus allowance needs to be made for individuality. But a child with Asperger syndrome does not necessarily have to attend a specialist school - an ideal support is a cooperation of the network class teacher, support teacher and special support assistant. They should be calm, positive and consistent and preferably have a good sense of humour. (comp. Cumine et al. 2001)
Key elements of effective intervention:
| Environment | |||
| Physical / sensory | Language / Communication | Social | Curricular |
| Physical structure | Help develop communication | Inform staff about social difficulties | Informed, tolerant and empathic teachers needed |
| Schedule Work systems | Help to initiate and maintain conversation | Help with making friends | Good classroom practice |
| Visual clarity | Help to understand meaning (skills) | Support to give a sense of self | Understanding of Asperger syndrome |
| Structure language environment | Support interaction of others (teach social skills - role play) | Concentrate on strength of c child | |
BEHAVIOUR PROBLEMS (Cumine et a]. 2000)
For many children with Asperger syndrome and for many teachers it is not the curriculum that causes problems but it is the non-curricular areas such as assembly, playtime, lunch break. The child may struggle with the following:
| Decoding people | Little awareness of others' feelings |
| Self concept | Problems to understand themselves |
| Imagination | Problems to plan alternative courses of action |
| Cracking language code | May not recognise instructions; may shout out responses inappropriately |
| Rigidity and rule-bound behaviour | Inability to abstract simple social rules from the problems with central coherence |
| Exclusive interests and obsessions | For the child intrinsically awarding; can be difficult to find a competing game |
| Compulsivity, perseveration, perfectionism | Hard to start or stop on activity |
| Integrated learning | Generalisation does not occur; concepts are not derived from facts |
| Sensory experience | Less marked and less frequent than in autism but children can be extra sensitive |
| Motor control | Poor coordination and handwriting may occur (teasing!) |
Try to take the point of view of the child...
... in order to understand the function and purpose of a certain behaviour. To identify behaviour is not to specify need. Some examples are given in Cumine et al. (2000). Problems con be avoided when:
- The environment is structured for prevention
- Rehearsal is used before an event takes place
- Rules are used in a positive way
- Calm, objective, emotionally neutral approaches to negotiations are taken
- Interests and obsessions are allowed and incorporated into programs
- Trying to remove potential stress triggers
Behaviour difficulties:
When behaviour difficulties occur, intervene systematically and base interventions
on careful, informed, methodical observation and data collection. (comp. Cumine
et al. 2000) One of the main things is, however, to build up a positive
relationship to the child.
Beck's plea: Go out to parents, educators, physicians and psychologists alike: contribute your knowledge in every positive way you can. Reject the urge to control others, and reject others who are trying to control. Knowledge, wisdom and contribution, not control, are what will help us find the answers we seek. (Beck 1999, comp. O'Neill 1999)