宇聯心理健康志業群

by Irene Chiang

[Abstract]
Attend program for children with this issue or age in the student’s home community and write a research paper discussing the needs and characteristics of this group as described in the literature, compare the way your presentation and the program the student attended addressed these needs and describe any changes the student would make to her program after viewing this program.

AUTISTIC CHILDREN – NEEDS &CHARACTERISTICS, WITH EVALUATION & DISCUSSION ON CLASS PRESENTATION & TREATMENT PROGRAM

Foreword

“What is it like to be in a room with six autistic children? Sometimes it is as if you are among six distinct planets in a strange solar system, while still within the same four walls. Sometimes it may feel lonely, as though you are the only one in the room” (Erfer, 1995, p. 191). This statement clearly describes the feeling if one stays in the same room with autistic children. They seem to live in their own world, and it is truly difficult for any other so-called “normal” people to really understand what they think and why they behave in certain ways. So, what really is autism?

Characteristics

“Autism is a complex developmental disability that typically appears during the first three years of life. The result of a neurological disorder that affects the functioning of the brain, autism and its associated behaviors have been estimated to occur in 2 to 6 per 1,000 births (Centers for Disease Control and Prevention, 2003)…. Autism is four times more prevalent in boys than girls and knows no racial, ethnic, or social boundaries.” (ASA, 2004, online resource). No matter how controversial some common thoughts might be, autism is actually not an illness, and this kind of disability does affect “sociability, language, and a variety of brain functions” (Erfer, 1995, p. 191).

Autistic children have severe difficulty with sensory processing, and this kind of complexity is a distinct characteristic of such disorder. Autistic children tend to look for unusual quantities of certain kinds of sensations, yet they have extreme hypersensitivity toward other kinds (SII, 2004, online resource). Next, it is not true that autistic children do not care about outside stimulants; they care so overly that they are forced to retreat to their own world because of extreme sensitivity (Stacey, 2004, p. 92). Generally, children with autism have the following characteristics:

(a) Ideosyncratic Behavioral and Habitual Pattern
　　Autistic children often have fixed habits or behaviors which are different from that of normal children, such as engaging in “idiosyncratic movement patterns” (Levy, 1988, p. 222) and having “restricted interest” (Chang, online resource) - wearing the same type of clothes, eating the same sort of food, walking the same route every time they go out, unique and limited interests and preferring the same interior decoration style. Any changes on the aforementioned aspects will cause their discomfort and verbal / physical resistance (AAET, 1999, online resource).

(b) Self-Stimulating and Perseverative Behavior
Autistic children show self-stimulating and persevrative behaviors. For example, they frequently do hand flapping, rocking back and forth and even some self-hurting behaviors such as head banging. With much repetition, though, their attention seems unfocused and their behavior disorganized. Some autistic children are overly active, but others are extremely passive and rarely move (Erfer, 1995, p. 192).

(c) Motor Control Problem
When feeling excited, autistic children might grimace, jump up and down, or do other seemly odd physical reactions to show their excitement. Even when being quiet, some autistic children would show awkward posture or do quite unusual gesture, and others learn by watching and imitating other people’s movement. In additions, they are not able to tell left from right, up from down or front from back (Erfer, 1995, p. 192).

(d) Communication Difficulty
Autistic children seem not to have interests on or understanding of verbal and non-verbal language. The only way they appear to be communicating is usually through echolalia – “the production of words or phrases that seem to be an exact copy of those originally spoken by another person” (Erfer, 1995, p. 193), and what they express does not have real meanings. Moreover, the fact that they tend “to pay attention to only one aspect of a person, object, or scene, instead of the whole” (Erfer, 1995, p. 193) also has an impact on their perception ability, causing their “social deficit” (Chang, online resource).

Needs

Autism is such a unique and delicate condition that treatment approaches should be carefully planned. Also, therapists and people who get in touch with autistic children have to pay extra attention on their own attitude and adjust according to individual situations as well for catering to needs of such children.

(a) Immediate Guidance
When autistic children behavior improperly, cause some trouble, or talk / react strangely due to difficulty on emotional control, they need to be taught the proper way (in action) of behaving or handling things immediately (AAET, 1999, online resource). It will be extremely harmful if they are being laughed at or even blamed.

(b) Observation and Contact
Autistic children often get nervous and wander around, or even scream loudly when losing something or feeling physical discomfort; therapists should observe before inquiry. For those who do not voluntarily contact others, it would be better to call their names and have eye contact directly with their eyes (AAET, 1999, online resource). Next, it is crucial for autistic children to establish “contact, trust and rapport. Touch is necessary to help define body boundaries and establish connectedness to the therapist and…. the outside world” (Levy, 1988, p. 227). Therapists should be responsive, sensitive and initiate all avenues of self-expression and learning in a creative way (Levy, 1988, p. 228).

(c) Movement and Non-Verbal Communication
Movement and non-verbal communication is an effective way of contact because autistic children usually have not yet developed communicative speech, but mostly do have a unique movement language. Movement, activities and interaction help them to be more aware of themselves and become more capable of interacting with others. Especially with dance movement therapy, therapists need to know their own body movements and find a way to communicate with that of autistic children (Levy, 1988, p. 223), work toward the direction of trust development and relationship formation (Erfer, 1995, p. 197), and gradually head toward behavioral modification.

(d) The Concept of Body Image
“Body image has a physiological basis…. The development of body image parallels
sensorimotor development (Erfer, 1995, p. 197). Since autistic children have problems on sensory integration, the key is to “reach these children at their own developmental level, this is the primitive sensory-motor level” (Levy, 1988, p. 222) in order to guide them toward a change in the psyche from a change in body image. Movement changes or modification on the physical level can affect a person’s total functioning (Erfer, 1995, p. 198).

Observation on Treatment Session

On October 6, 2004, I went to the Child Psychiatry Department at a local hospital to view a treatment session for autistic children. It was a one-on-one session with a teacher and an autistic child about five to six years old. When I entered the room, I saw the pair sitting face to face in the center of the room, the teacher was sitting on one arm of a sofa-like base chair, and the child kneeling on a medium back pneumatic chair (the kind that could swivel), with the child's body front leaning on the back of the chair. They were happily interacting and laughing continuously.

The teacher frequently turned the pneumatic chair, talking, praising and singing to the child, and asked the child's preference of her singing a song. The child just kept on laughing with great interests and attention to her. After a while, we heard the sound of the alarm from outside, and the child paused, looking attentively. The teacher asked the child what kind of sound that was, and then told the child what that was. The child listened for a while and restart laughing.

I noticed that they had some kind of “intermission” that the teacher encouraged the child to shake hands with her, and when that was done, the “chair turning” (in the same place or in a circle) would resume. Also, I noticed that the child held a hospital brochure in the left hand. The child did not read it, and merely enjoyed holding it in the hand. Later, the child began to drool, and the teacher did not wipe the child's chin, just kept on playing with the child.

During my observation, the teacher told me that it took her a long time to find out the pneumatic chair would be a perfect stimulant for the child. When the child was waiting for the session to begin on the hallway, she said, the child was screaming almost non-stop and appeared quite impatient, but the moment the child entered the room, the child knew that the sitting place would be the child's favorite chair, so the child had a mood change and turned happy and attentive. Without the chair, the child would not even glace on the teacher.

After fifteen minutes of playing, the teacher told the child that it was time for the “lesson,” and walked to the closet to take out a small plastic basket of several plastic clothespins (the kind for hanging clothes outdoors). She then walked to the other side of the room and sit beside a table, but the child still remained on the chair. After much encouragement, the teacher walked to the child and led the child to the “lesson” site, and the pair sat face-to-face once again. She explained to me that the child is not especially fond of such lesson, and would walks to the door to show the desire to go out. I noticed that she put her right leg beside the child on the corner of the chair, probably for the purpose of “stabilizing” the child.

Later, she asked me to stand up for her to move my chair in front of the door to “block” the exit before I could sit back on it. The child went back and forth between the child's location and the door. In fact, they switched between doing the “lesson” and playing the “chair game.” Sometimes, the child would wander around the room, and the teacher told me that the child's legs are weak that the child appeared dickering, but it is necessary for the child to personally walk without assistance. Later, she suggested me to switch to another seat for me to view the child without turning my head.

When she saw me paying attention to the child turning the door handle, she asked me to switch seat, and after doing that, the child started pushing my original chair. The teacher said that turning the door handle or pushing the chair was actually good for the child, just like she held the child's hands to take and return the clothespins in order to have the child practiced and felt the sense of “touch,” and learned to response to a certain instruction. The child also performed head banging onto the door, and the teacher had to use her right hand for the child protection.

This child is actually a severe case. After fifteen months of treatment and continuous sessions at a local center for development, the child progress is still very slow, and the child would not be able to attend an “inclusive” class at a normal elementary school. In additions, the “chair game” is the only time the child would pay attention to and look at anyone, and when the child goes back home, it is very difficult for the child's family to deal with the child's situation. During the fifteen months she has been with the child, they only meet thirteen times, and it is due to many factors.

Conclusion

“The movement therapy sessions led to an increase in attentive behaviors and a decrease in stress behaviors” (Hartshorn et al, 2001, p. 4). After the observation, I have learned a lot and realized that my original lesson plan presented on our class truly need adjustments. I noticed that the teacher only do two things with the boy, and what she did was to help him obtain the following: more agile movement, normal reactions toward sensory stimulants, greater senses, cognitive and language development, improvement on hyperactivity, and increased attention and emotional maturity (Chang Gung Memorial Hospital, 1988, p.1). I put far too many tasks into my one-session plan.

Since the piano appeared to be a great attention getter, I would increase the amount of time on piano, and guide the participants to small movement, such as nodding and hand clapping, according to the rhythm. Next, since they reacted well on my slightly touching their feet, I would have one-on-one interaction with each of them and guide them to touch my feet as the way to response. As to the big red ball, some of them responded and pushed it back to me or another member in the group, but others seemed not interested. I think that I need to reduce the amount of time spent on the ball, and only asked them to touch and pushed it back to me without further physical movement.

Moreover, I would also omit all the other parts of my lesson plan, including “bubble to wave,” “emotional mime” and “I have wings,” because they were too difficult for them to comprehend, and the aim of movement experiences was actually to help them “in developing an ability to focus, to attend to tasks, to delay gratification” (Leventhal, 1979, p. 174). Next, although some of the participants reacted well to the tearing newspaper in “I have wings” activity, I would probably hold that and concentrate on the aforementioned sensory and instruction-response activities, because the situation could turn chaotic if not planned well in advance.

Based on my observation, the teacher did adjust according to situations, and although I did that too on my own movement experience, I would have myself better adjusted to each one in the group, because “the processes of attunement and adjustment enhance every therapist’s ability to make clinical choices” (Loman, 1998, p. 222), and be aware of safety issues as well. Finally, I would also use piano for the closure as a reminder for what they have experienced in this session, but without leading them to sing with me, because the purpose was not have they learned to sing, and this kind of concept might as well be too advance for them to understand. Music here was used as a stimulant for movement and response, and to increase their degree of focus and attention.

[References]

Chang Gung Memorial Hospital. (1998). Sensory Integration Disorder. Taipei: Chang Gung Memorial Hospital.

Erfer, T. (1995). Treating children wit autism in a public school system (pp. 191-212) in F. Levy (Ed) Dance and the other expressive arts: when words are not enough. New York: Routledge.

Hartshorn, K.; Olds, L.; Field, T.; Delage, J.; Cullen, C.; Escalona, A. (2001). Creative movement therapy benefits children with autism (pp. 1-5) in Early Child Development & Care. 166.

Leventhal, M. (1979). Structure in dance therapy: a model for personality integration (pp. 173-180) in P. Rowe & E. Stodelle (Eds) Dance Research Collage: Dance Research Annual CORD, 173-180.

Levy, Fran J. (1988). Dance therapy with the special child (pp. 221-233) in Dance movement therapy: a healing art. Reston, Virginia: American Alliance for Health, Physical Education, Recreation, and Dance.

Loman, S. (1995). A KMP approach to autism (pp. 213-224) in F. Levy (Ed) Dance and the other expressive arts: when words are not enough. New York: Routledge.

Stacey, Patricia. (2004) Open the hearts of autistic children (pp. 92-97) in Readers Digest, June 2004 TW.

[Online Resources]

Association of Autism Education in Taipei (1999). Understanding Autistic Employees in Disability Information Network. Available: http://disable.yam.com/resource/career/employer/know/autism.htm

Autism Society of America (2004). What is autism in ASA Online. Available: http://www.autism-society.org/site/PageServer

Chen, Y.S. (2004, August 1). DMT: prescription of stress release for the mind in the new age in China Times Online. Available: http://ec.chinatimes.com/scripts/chinatimes/iscstext.exe?DB=ChinaTimes&Function=ListDoc&From=2&Single=1

Sensory Integration International - The Ayres Clinic (2004). Answers to frequently asked questions in SII Online. Available: https://mmm1106.verio-web.com/sensor/faq.html

Chang, S.L. (year unknown). Another kind of special children: Asperger syndrome in Chang Gung Children’s Hospital Online. Available: http://www.cgmh.org.tw/chldhos/intr/c4f60/Information/另類星兒---亞斯伯格症候群.htm