Aut Aut

Autism Spectrum Disorders

 

and treatment at school

Katia Tonnini, supervisor for ASD children

1. Brief history of autism

2. Problems related to autism

3. Behavioural approach

4. Diagnostic criteria

5. Treatment and education

6. Bibliography

1. Brief history of autism

The term autism comes from the old greek word autòs that means to be closed and to be fold on himself.

This term has been used in psychiatry in 1911 by Bleuler, in order to define one of the peculiar characteristics of the schizophrenic psychosis in adulthood.

After that, in 1943 Leo Kanner, a childhood psychiatric coming from Austria but working and leaving in the USA, used the same term to define a specific disorder. The researcher had found some common sympthoms in eleven boys, that showed developmental anomalies and difficulties in social relationships.

They showed the following sympthoms:

· Physically beautiful children, they looked like closed in a “shell”

· “Sameness” or insistence for the same things

· Incapacity to entre in contact with other people

· Verbal language development was later than normal

· Verbal language was used not to communicate

· Motor stereotypies

· Absense of imaginative and creative activities

· Good, often “extraordinary”, intellectual level

During the 50s and 60s, Bruno Bettelheim supposed that the Autistic Syndrome was caused by the wrong stimulation given by the parents, expecially in matter of emotive and affective exchange, personal cures and demostration of affectiveness.

In his opinion the wrong way parents -and expecially mothers- kept in touch and stimulated their children, caused the “retire” of the baby in an “empty fortress” and determined their closeness towards the rest of the world and their inability in socialization.

In the 70s Doctor Shopler, an american psychiatician, after having made many scientific researches about autism, considered it was caused not by a wrong parent’s stimulation, as Bettelheim supposed some years before, but probably by a genetic “problem”.

Even if this is considered (till now) the most perspective thesis, at the moment we do not have a scientific trial of this idea. He also elaborated a new approach of teaching to autistic children, the TEACCH program which implies cognitive, behavioural and psycho-linguistic strategies based on education and prevedibility.

2. Problems related to autism

One of the more controversial definitions given by Leo Kanner was about the autistic children’s intellectual level. In fact the idea of extraordinary intelligence made people believe (until now) in the “Rainman myth” (coming from the famous Stevenson’s film), that attributes to the autistic subjects an enormous and untrue intelligence.

The reality of clinical practice shows, in the contrary, that about the 65-70% of autistic children have cognitive difficulties.

The error of evaluation has been caused by what we today call “ability isles” which are extraordinary capacities that just a little part of the autistic population has (such as, for example, the calendar memorization, or the capacity to solve quickly very difficult calculus, or the knowledge of all the part of uman body, ect.). Those “isles of ability” are determined by hyper-attention on one or very little number of subject-matters by autistic children that have a quasi-normal intellectual level and social functionning.

Moreover Kanner, defining those children as affect by autistic disorder, underlined in particular their incapacity to develop an affective and emotional based relationship with other people (neither with their family members).

Afterwards psychodinamic psychopathology attributed the cause of the autistic disorder to a pathologic family setting and in particular to inadeguate mother’s behaviours. Bettelheim was the first to speak about ”icy-mother” in order to define the detached behaviour and the wrong-way modality of the mother to keep in touch with her baby.

Going back to the first Kanner’s interpretation, we can demonstrate what he considered the causes of the Autistic Disorder. In fact, the researcher spoke about “congenital incapacity” that means innate and non-later determined.

As I said above, at the moment we do not have scientifical trial of the innative thesis, but, once again, clinical practice give us many empirical proves.

The nature of autism and how to intervene have been the centre of many quarrels and harsh controversies between different currents of thought from 1943 till now. No other disease had never created so much disagreement inside the scientific community.

3. The behavioural approach

Today, the autistic disorder etiology seems to be connected more to neurobiological than setting factors.

Many researchers are studying cromosomical and genetical map in order to verify their thesis, even if at the moment it is not confirmed. Even if we can’t attribute to action a scientifical value, the clinical practice demonstrates the truth of this thesis.

First of all, the clinical practice shows that a wrong-way family interactions or behaviours not necessarily determines Autistic Spectrum Disorders (ASD). In the contrary, the autistic children often have adeguate and “non-icy” parents. At the same time, we have many examples of really high-risk family settings where no autistic spectrum disorder is connected.

Moreover many casese of similar disorders in the origin family are connected to autism (we often find relates affected by language disorders, “madness”, mental and developmental retardation, and sometimes, we even find cases of brothers/sisters or twins with autism). This evidence makes the scientific opinion believe about a neurobiological etiology.

Behavioural approach considers the Autistic Spectrum Disorders origined by an organic neuronal disturbance: surely, setting can condition the syndrome development into a positive or negative evolution, but it probably can’t determin it.

In order to define a disturbance as autistic syndrome, the whole sympthoms must appear not later than 36 months, otherwise we cannot define it as autism.

4. Diagnostic criteria

DSM-IV (the medical handbook defining mental disorders, wrote by the American Psychiatric Association) defines three compromising areas for the autistic syndrome:

1) Qualitative compromised social interaction (lack of looking into their interlocutor eyes, lack of mimical expressiveness, inadeguate body posture and gesture); inability to start and develop a relationship with other people, expecially of the same age; lack of affective social reciprocity.

2) Qualitative compromised comunication; lack or retardation of language development and lack of compensation with gesture; if language is adeguate, autistics are inable to start and develop a conversation with other people; stereotyped and ripetitive language not used to comunicate.

3) Limited and persevering behaviours, interests and activities (such as motory sterotypes, restrict interests in one or very little subject-matters, oggetti) and lack of creative and immaginative activities (no symbolic play, etc.).

5. Psycho-educational treatment

Following the controversial history of autism, we can observe that at every change of ethyologic theorical interpretation has followed a changement of intervention on autistic subjects.

Kanner used to think about autistic boys as “idiots savants”, because of what he believed their “extraordinary” intelligence. For this reason, he used to separate them from the rest of society and send them to special psychiatric clinics in order to study that “strange” and “new” pathology.

Bettelheim considered autism as a psychological disease and, for this reason, he proposed to “cure” children with psychoanalis, in order to reorganize their lost self-perseption and create a new imagine of their-own.

Many cures have been proposed but unfortunately they cannot solve what is naturally compromised. What we today know about autism is that there is no cure for it: we just can speak about treatment and education of autistic persons. The only way to teach autistic subjects cognitive concepts and social rules is to educate them.

Cognitive and Behavioural approach and evolutive and psycholinguistic theories such as the TEACCH programm (Treatment and Education of Autistic and Communication Handicapped Children, coming from E. Shopler, North Carolina), TED thérapie d’échange et dévelopment (coming from Lélord and Barthèlmy, France), Applied Behavioural Analisys (ABA, Skinner), Denver Model (S. Rogers), represent just some of the most useful approaches to intervention, whose long-lasting efficacy has been tested in many scientifical studies.

Those different psycho-educational treatments are based on autism positive caracteristics: their good visuo-spatial abilities, their need of prevedibiliy and structured organisation of time and space, their need of repetition and structured education.

6. Bibliography

· Jordan e Powell, Autismo e intervento psicoeducativo, ed. Erickson, 1997, Trento.

· Xaiz e Micheli, Gioco e interazione spontanea nell’autismo. Cento idee per favorire lo sviluppo dell’intersoggettività, ed. Erickson, 2001, Trento.

· Brauner e Brauner, Storia degli autismi. Dalle fiabe popolari alla letteratura scientifica, ed. Erickson, 2002, Trento.

· Shopler et al., La comunicazione spontanea nell’autismo, ed. Erickson,1997, Trento.

· Powers, Autismo. Guida per genitori ed educatori, Raffaello Cortina Editore.

· Beyer e Gammeltoft, Autismo e gioco, Phoenix Editore.

· Visconti et al., Il mondo di Alessandro, Phoenix Editore.

· Shopler et al., Attività didattiche per autistici, Phoenix Editore.