Autistic Spectrum Disorder and T by sin15395


									              Autistic Spectrum Disorder and T.E.A.C.C.H.

These notes represent a summary of the presentation by Dr. Gary Mesibov, Director
of Division T.E.A.C.C.H., highlighting the theoretical underpinning of the
T.E.A.C.C.H. approach and its associated values, together with an exploration of
more general issues.

M.J. Connor                                                            July 2001
               Autistic Spectrum Disorder and T.E.A.C.C.H.

         The Perspective from Gary Mesibov (University of North Carolina :
              (Presentation at Linden Bridge School : June 30 th 2001)

Critical elements to promote progress:

     -      Clear strategies
     -      Teachers with strong personalities who can modify programmes or assert
            particular interventions
     -      A flexibility of approach.

T.E.A.C.C.H.……Theoretical Ingredients:

    A recognition that Autism is not an emotional disorder, not a function of
     ineffective mother-child interaction, but a specific and multi-causal condition
     requiring a very structured intervention.
    The common theme in etiology is that of a neurological disorder and autism
     cannot be viewed in psychoanalytic terms.
    The significance of visual skills or visual style among children with autism,
     compared to relatively weak skills in respect of auditory-verbal “channels”.
    The goal is to enable parents to become effective teachers of their autistic
     children (which would further underline that the parent is not the cause of the
     autism), and the immediate schemes involve:
     a)     visual approaches
     b)     high structure
    The need to gain some insight into the way the autistic child perceives the world
     and events around him/her and one significant feature is that of “thinking in
    A general principle is that of enabling the autistic children to make sense of
     what happens round them … to understand the meaning of events … thus to
     reduce anxiety and, in so doing, to improve behaviour and provide a means for
     them to communicate their needs and wishes.
     [The simple example is given of aiding a child to complete a sorting task by
     using transparent containers thus enabling him/her to have a consistent visual
     reminder of what the sorting “rule” is].
    How does one explain task requirements in such a way as to make sense to the
     narrow interest that is autistic individual? One “avenue” may be that of using
     the very characteristic that marks the autistic person, e.g. when teaching to
     read, one would focus upon that narrow interest for showing the purpose of
     reading and generating reading practice material.
   T.E.A.C.C.H. focuses on making things meaningful (in contrast to behavioural
    methods where the emphasis is on reinforcement). The procedure is highly
    person-centred rather than based on some overall philosophy [such as the
    general principle of mainstream inclusion and is an alternative to behavioural
    approaches which attempt to fit the child into what is seen as “normal
   There are, therefore, clear values or “spirit” associated with T.E.A.C.C.H. and
    among all staff concerned, including:
         attempts consistently to get to understand autistic behaviours and the
         experiences of the individuals, not being judgemental about behaviours,
         but seeking to understand their source, accepting individual differences
         and respecting those differences, trying to see events through the eyes of
         the autistic individual and how they might be interpreted, a striving after
         excellence (seeking the best outcomes for the children and maximising
         efforts to make their lives better), a form of perfectionism on behalf of the
         children, a persistence in seeking possible answers, a pragmatism or a
         willingness to do whatever has to be done without worrying about role or
         rank demarcations, collaboration and co-operation among all concerned
         (and a reducing or avoiding of professionals’ job boundaries or
         specialisms), an emphasis on generalisation of skills and knowledge
         developed, a positive spirit in looking for the best outcomes while
         highlighting strengths in the child and his/her family, and an optimism that
         the children can lead happy and productive lives (albeit not denying the
         difficulties or promising a cure).

    There is an acknowledgement of the variety of approaches available to autistic
    children and their teachers and carers, and one would further acknowledge that
    these various approaches may be entirely valid in reflecting the values and
    principles held by the individuals concerned. One may need to be ready to
    preface targets and strategies by referring to one’s individual perception of what
    autism is all about and one’s associated practices. An implication is to highlight
    what are the common themes or the universalities among the various
    approaches, and what are the shared values and philosophies.
    Among the shared targets may be that of enabling the individual to become
    usefully and happily involved in the adult work force … alternatively it may be
    a matter of enabling the individual to use play, recreational and cultural
    facilities. In any event, the need is to have some awareness or agreement
    concerning what is one preparing the autistic individual for. How can one best
    improve his or her life?
Specific Issues (stimulated by questions)
Can the single diagnostic term “autism” fully describe and cover all the levels
and types of need?
The critical need is to recognise the concept of a continuum, and to be cautious
about describing a child as being a “classic” case of autism, while seeking more
accurately to describe various subtypes, e.g. can one be consistent in the
meaning of Asperger Syndrome?

What might be seen as the core elements of a baseline assessment of a young
autistic child?

It is difficult to specify a generally acceptable set of baseline measures.
Different individuals or organisations may have different desired outcomes.
Differing theoretical orientations will equally have different anticipated or
desired outcomes. All of this will influence initial decisions about how to
establish a baseline … even leaving aside political considerations. In the long
term, the existence of different approaches will provide cues and clues about
matching children with particular strategies. However, any programme should
be able to document progress by means of repeated administration of checklists
or measures thus to highlight gradual decrease in errors, less destractibility, less
dependence on prompts, etc. If an LEA is to fund a programme, it would be
reasonable to have the funding request backed by a clear indication of the
evaluation system to be used
     language understanding         }            are areas which might
     communication                  }            usefully be emphasised
     general ability                }            (as set out by Rita Jordan)
but it is important to recognise the value-driven nature of appropriate education.
Meanwhile, the critical issue is to maximise the amount and different types of
stimulation impinging upon the young child thus to maximise the probability of
appropriate development of C.N.S. functions. Precise methods, be it ABA or
Lovaas or Son Rise, may be of less direct salience.

Impact of Technology?
The autistic child may particularly lack a system of organisation
One may find that palm-held organisers will have some relevance and benefit
for many children with Autism. Meanwhile, communication aids which
produce stock questions or phrases may not be helpful since the issue may be
less about producing utterances than about ensuring meaningfulness and truly
pragmatic communication.
Next Steps?
     The major issue is coping with or making sense of the enormous numbers of
     children diagnosed with autism. How does one provide for such numbers?
     How does one ensure early intervention for all the children concerned? How
     does one manage training implications?
     A further issue is that of creating more flexibility within and among
     programmes and interventions. In any classroom, or programme, one may need
     to ask what the child is missing … what is not available. Can one link special
     school provision with mainstream provision and enable children to gain
     advantages from both, rather than adopting a more rigid policy (such as
     “inclusion for everyone”)?

     How can one combine and integrate options?
     Meanwhile, it is necessary to highlight which children do best on which
     programmes…. T.E.A.C.C.H., A.B.A., Lovaas, SonRise, etc…..rather than
     have each programme’s proponents claim that its programme is the best for all.

     Very early identification (pre-natal “diagnosis”)?
     A risk is for a temptation towards termination in the case of foetuses which are
     found to have a high genetic probability of autism. This begs the question of
     how to put relative values on different given profiles or strengths and
     weaknesses. On the other hand, unlike Down Syndrome, it may be very
     difficult if not impossible to gain sufficient confidence in genetic profiling to
     make it predictively valid for a diagnosis of autism. Autism may reflect the
     operation (or non-operation) of a number of genes.

     Levels of ability (?peer groups)
     A group may be organised via a shared diagnosis of Autism, when there may
     still be much variation among members of the group in cognitive level. Without
     underestimating the general organisational issues common to autistic children, it
     is still important to recognise developmental, cognitive and emotional ages.
     Learning style may be a critical factor for grouping children and probably more
     significant than an IQ score. Again, flexibility is the key concept, and balance
     among groups may be the main issue.

     Why more cases of Autism in the recent years?
     There are more cases, it is not just a matter of better diagnostic strategy.
     [However, the concept of spectrum may have enabled a greater number of
    Further, the precise types of autistic difficulties are changing, e.g. the percentage
    of cases with severe learning difficulty or with no language seem to be shifting.
    Factors might include the temporal changes in genetic conditions or
    susceptibilities, perhaps with intensification over time (with “marked” autism
    observable in the offspring of two parents with mild autistic features).
    Environmental or toxic influences may trigger events in susceptible people …
    with evidence linked to drug studies such as those about thalidomide which
    suggests behavioural/autistic as well as physical impacts. Other toxins include
    air pollutants, and dietary components. Perhaps the M.M.R. issue still needs
    further exploration. Do young girls have more efficient immunological systems
    than boys, hence the greater risk among boys?

    Teaching emotion in individuals who seem unfeeling to other people
    It may be a matter of the history of bad experience with relationships … a
    learned fear or anxiety. One might simply focus on a person in a particular
    situation, and ask the individual very specific questions …. What would he feel?
    What would he do?, etc., all designed to enable the individual to understand the
    anxiety that others feel … they may need to be told what other people have fears
    or anxieties about thus to enable them more readily to identify with other

    How and when to talk to children about their autism
    When the children begin to notice their difficulties or differences. There is little
    point in raising such matters before the child has any awareness of the autistic
    behaviours. It may be that what the children believe or fear is much more
    negative than the information that they will be given, i.e. not mad, bad, etc., but
    different, and it’s OK to be different; and there may be positive features such as
    the existence of many other people very similar to themselves.

Summary completed by M J Connor                                       30 June 2001

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