Coping skills for people with autism most
often
include ‘withdrawal from the fabric of social life’ and this also is
reflected
in the isolation that many families experience who are dealing with
autism.
For some, coping skills include isolating themselves from the demands
of
the world and tuning out the world with every ounce of their being.
When
they succeed in the most withdrawal possible, limit the incoming
stimuli,
develop ways to cope with the discomfort of their bodies and succeed in
being
left alone, many are able to entertain themselves endlessly. Some
appear
genuinely happy and self engaged in repetitive actions and as long as
their
expectations are met and the routine is unchanged the family may be
able
to cope. Yet most often parents are unable to accept that this is all
that
is possible for their child – more so when the child had previously
developed
language and was social before the onset of symptoms became obvious and
increasingly
severe. The ‘safe world’ that these children have created to cope with
their
autism may be far more comfortable then any we can offer, especially if
the
sufferings which they are experiencing are not addressed and treated,
and
the differences they experience are not identified and accommodated. We
must
have the same determination they have, to gather information, develop
profiles
and understand the people who have this condition before we can begin
to
effectively develop programs and therapies which are designed to help
them
overcome their ‘withdrawal’.
It is very overwhelming to accept
that
some of these individuals who were isolated but coping in ‘their world’
have
been brought into programs and therapies by parents and professionals
attempting
to find the right therapy, right drug, right intervention that will
somehow
release their child from this invisible bondage, but instead led them
to
develop more dangerous, violent and aggressive strategies for being
left
alone. Others simply became more manipulative, or developed resentments
that
surface later.
Many of these children interact with their environment and with
people
in their environment on their own terms. Instead of isolating
themselves
and being self-entertaining, the child feels the strength and
determination
to explore and demand learning tools, entertainment objects, outings to
their
favorite fast-food outlets. Some experience the early excitement of
control
and use their experience to control their familiar environment more and
more.
Often they are able to transfer these skills to controlling other
environments
such as school and therapy settings. They often become experts at
manipulation,
especially when exposed to therapies which attempt to manipulate them.
To those living and working with children who are not
interacting,
who are lining up objects, tearing paper all day, touching the walls
ritualistically,
eating non-food items, emptying the contents of purses, stepping on
toes,
flipping the light switches on and off, touching personal objects and
expensive
equipment, touching people inappropriately, the response is naturally
to
want to spend less and less time with these children. Possibly there is
a
subconscious effect which has rippled through society. If I do not want
to
spend time with this child, then no one else would either. No one wants
to
be subjected to this kind of experience. No one should be expected to
manage
this type of child other than a trained professional. So professionals
are
called in, and sometimes the results are good, and many times the
results
are a failure or a worsening of behavior, but with nothing else on
offer,
where are parents to turn?
Why programs fail
- Some behavioral intervention programs fail because the
behavior(s)
which have been targeted are not behaviors, they are symptoms.
- Some behavioral intervention programs fail because the
child
has not been adequately evaluated and he or she may be visually
impaired,
hearing impaired, have fine or gross motor deficits or medical
conditions.
- Some are experiencing pain, gastrointestinal discomfort,
fungal
overgrowth, vertigo, tinnitus, allergies, skin irritation, nerve pain,
swelling,
lip numbness, body numbness, headache. Illness and injury which may
provide
no real clues as to their presence in a population whose bodies process
pain signals differently.
- Some behavioral intervention programs fail because the
therapist
believes that if the child has demonstrated a skill previously then
they
should be able to repeat this skill when commanded to do so with the
appropriate
rewards in place. He does not consider that the child may not be able
to
perform on that day because they are experiencing symptoms which they
were
not experiencing when they successfully performed the task previously.
- Some behavioral intervention programs fail because the
repetition
is boring and the child refuses to be involved in the repetition.
- Some behavioral intervention programs fail because the
therapist
has not proven trustworthy to the child.
- Some behavioral intervention programs fail because the
reward
scheme is insufficient to interest the child.
- Some behavioral intervention programs fail because the
consequence
of refusal to participate is acceptable to the child.
- Some behavioral intervention programs fail because the
child
has learned equally effective behavioral modification techniques and
has
applied them successfully to result in the end of the therapy.
- Some behavioral intervention programs fail because the
parents
try to provide the program themselves and they have failed to integrate
providing
the program and maintaining the parenting role adequately.
- Some behavioral intervention programs fail because the
parents
and family are disrupted by the cost, time involved or disagreement as
to
the value of the program.
- Some behavioral intervention programs fail because the
child
has developed complex avoidance behavior which is sufficient to render
the
program ineffective.
- Some behavioral intervention programs fail because the
service
provider to student ratio is not adequate.
- Some behavioral intervention programs fail because the
child
is strongly affected by changes which are resulting from therapies and
intensive
interventions which are occurring at the same time.
The Desorgher Method - a holistic approach
The Desorgher Method is a holistic
approach
to bringing about emotional, spiritual, mental and physical well-being
in
people suffering under the condition of autism. It grew out of the
Professional
Parenting model known as ‘the Magic of the Family’, and has been most
successfully
used for those exhibiting the stresses and conflicts of adapting to a
world
where their condition is poorly understood and their survival has
depended
on developing coping strategies which have come to be labelled as
‘problem
behaviors’. It can be adapted for uses in many settings and for a wide
range
of problems and age groups, wherever struggle and survival strategies
are
standing in the way of relationship, growth, fulfilment, health and
happiness.
The Desorgher Method uses the following tools:
- Unconditional Love
- Ethnomethodology – Teaching individuals with autism how
to
‘join the tribe’ by joining theirs
- Functional Behavioral Analysis and method of application
- Setting the child up for success
- Symptom or behavior?
- Breaking down behavioral complexes
- Meeting the child’s needs (re. Maslow)
- Keep it simple – identify what the child likes and
dislikes
- Re-framing (replacing negative experiences and
associations
with positive experiences and associations)
- Identify problem behavior(s) to be targeted – not working
on
too many things at once
- Limiting unnecessary verbalization to focus on what is
important
- Role modeling
- Describing behaviors
- Tracking
- Coping skills for the carer – Don’t take it personally
- Dealing with guilt overload
- Peer Role Models
- Overkill
- Expectations
- Increasing participation
- How to achieve compliance – Pre-teaching, rewards and
consequences
- Schedule
- Goals and objectives – Short term, long term
- Results
Simply, we are trying to find in ourselves
the
potential for accepting responsibilities which come with working and
living
with people who are not ordinary and have not had an ordinary life,
people
who may have very little or no emotional maturity, sometimes no guilt,
no
remorse, no culpability. Attempting to manipulate people who do not
have
emotional maturity, culpability or who have not been able to develop a
sense
of who they are will be unsuccessful.
When we offer ourselves, our help, our love unconditionally,
without
expectation, then we are not as fragile, not as likely to be upset or
disappointed.
Forming a relationship with unconditional love means that under every
imaginable
circumstance you are willing to accept responsibility for the
well-being
of the individual who needs unconditional love. They will experience in
your
care that their essential human needs are respected and accommodated.
When
they are in your care they will not suffer from unnecessary physical
restraint,
they will not fear for their safety, they will not be put in extreme
conditions
of cold or heat for which they have not been prepared, they will have
food
and water, rest and access to toileting facilities. When they are in
your
care they will be respected and protected.
It is a long journey through
childhood
and some are able to see themselves as others see them at an early age,
others
never reach this level of self-awareness. If you have never known what
it
is like to see clearly, hear properly, taste and smell without fear and
experience
loving touch then the tools for looking at yourself as others see you
simply
are not there. In order to help people with autism reach this level of
development
we first have to be able to see the world through their eyes, hear the
world
through their ears, feel as they feel, and acknowledge the food and
feeding
relationship of the individual as part of who they are. We might also
need
to realise that they are seeing, hearing and experiencing things beyond
the
range of ‘normal’ human experience.
If we cannot provide the kind of
care
and program which would be able to maintain staff to work directly with
these
children then they are destined to life in an institution. Many people
feel
‘it is not my responsibility’ to develop community-based support for
these
children and their families and they do not want to accept this
responsibility.
We certainly have not seen many medical doctors demand their rights to
treat
these patients. Very recently, when the paradigm shifted towards the
medical
aspects and research forced medicine to begin to prepare for the
change,
some doctors began demanding education and resources but this change
has
not been fought from inside the medical community – it has been forced
as
parents whose children have been denied care shared information and
created
greater awareness, and as a result of doctors facing the challenge of
parenting
an autistic child themselves and who have worked to produce research
findings
showing the biomedical aspects of the condition to be consistent.
The combined approach
The combination approach of dietary and
behavioral
therapies are designed to effect powerful changes, and we have to watch
intensely,
24 hours a day. As they experience changes to their eyes, ears, sensory
experience,
physical bodies they may be frightened. Some may feel more capable and
able
to assume control of their environment and others less capable. As they
are
‘waking up’ from the most deeply withdrawn state of autism, how any one
individual
reacts depends on their circumstances, their attitude, what they
experience
and how others are responding also to the change. Of course having
carers
in place who have been through the process themselves or seen others go
through
the transformation is invaluable. Family members, especially siblings
of
autists who have experienced this process will be a tremendous asset to
us
in the future, as well as those who have experience of other
transformational
therapeutic programs.
Methods for applying behavioral
intervention
are based on the findings from the functional behavioral analysis and
knowing
the child. Look at his or her entire day. Determine when and where the
problem
behavior occurs. Target the most serious behavior(s) first. Set the
child
up for success. Separate symptoms from behaviors and this means the
child
must have all necessary medical and professional evaluations. The
behavioral
intervention must be modified and adapted instantly to meet the
ever-changing
needs of the individual. There must be consistent effort to instantly
recognize
symptoms or behaviors which are resulting from their experiences and
attitudes
about themselves and how they are coping with their physical and mental
state
in response to the current setting and demands. Frustration levels rise
and
fall continuously during any given day and during each activity or
period
of inactivity, so do hormone levels. The schedule must be in place and
supply
the child with visual information which identifies the next break, the
next
change and the time frame must be adjustable but consistent. Break down
behavioral
complexes to manageable goals and objectives for reducing and
eliminating
the most significant behaviors first. Meet the child’s basic human
needs
unconditionally, in a timely manner and work towards developing trust.