working together with autism by Mostafa Ewees


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working together with autism by Mostafa Ewees

  1. 1. How can we make inter-agency work more effective ? Dr Mostafa Ewees (Senior educational psychologist, Stanford University at California)
  2. 2. <ul><li>… if you build your house on a busy highway you must expect many visitors … Kanner ( quoted by Bennett and Billington, 2001)* </li></ul><ul><li>... Like ‘peace’ and ‘love’ everyone agrees multidisciplinary work is a good thing but there is no agreement on what it might look like … (paraphrasing Jordan, 2001) </li></ul>*Lloyd-Bennett, P and Billington, T.(2001) editorial, Educational and Child Psychology 18(2)
  3. 3. <ul><li>To establish some principles to guide effective work </li></ul><ul><li>To look at practical examples to illustrate these principles. </li></ul><ul><li>To consider the range of skills and perspectives needed </li></ul>
  4. 4. <ul><li>my jobs and interests </li></ul><ul><li>some initial ideas </li></ul><ul><li>- what are we talking about ? </li></ul><ul><li>- why ( are we talking about it ) ? </li></ul><ul><li>- how ( can we improve the situation) ? </li></ul><ul><li>Task : ‘Listening to Kenneth ‘* </li></ul><ul><li>1. strengths </li></ul><ul><li>2. challenges </li></ul><ul><li>3. what needs to </li></ul><ul><li>happen ? </li></ul><ul><li>* Extract from ‘ Different for a reason ’ BBC Radio 4 (23.9.01) </li></ul>
  5. 5. <ul><li>How to we achieve this ? </li></ul><ul><li>Hearing the voices of people with autism … </li></ul><ul><li>What we need to know can be learned from the people themselves …. </li></ul>
  6. 6. <ul><li>‘ I have difficulty finding out what other people are feeling and thinking , its what people call mind reading. I also have difficulty making expressions and knowing what’s appropriate , like what kind of eye contact …’ </li></ul><ul><li>‘ When I ‘m In social situations I usually feel very nervous or anxious, especially if around people I don’t know well …I don’t know how to behave at all , I have to pick up cues from other people …’ </li></ul><ul><li>‘ Some emotions are more difficult than others: fear, anger, surprise because it can be very similar in the way people express them – especially if they are mild.There are very small cues ( clues) between them …I’m not picking up…’ </li></ul><ul><li>‘ It’s really hard work to learn , it’s really difficult because no-one writes books about it. Everyone assumes it comes naturally to everyone…’ ( Chris, student, from ‘The Face’ Channel 4, 2001). </li></ul>
  7. 7. <ul><li>Differences or difficulties ? ( Donna Williams,1996; Kenneth Hall, 1998) </li></ul><ul><li>‘ My world is not simply a damaged version of yours …’ ( Jim Sinclair, 1992 ) </li></ul><ul><li>‘ these individuals are the experts on their autism and should be our future collaborators in our understanding of autism’ ( Peeters, 2000 ) </li></ul><ul><li>‘… in the playground I always tried to find a quiet corner, in the classroom I tried to find a quiet corner to do nothing at all ( Kenneth Hall, 1996 ) </li></ul><ul><li>‘… the sound of the children’s voices was like dynamite in my ears …its hard to know what’s expected of me, I like it when things are clearly explained and there are clear, fair rules…’ </li></ul>
  8. 8. <ul><li>link to ‘understanding autism’ </li></ul><ul><li>sources of information (and overload !) </li></ul><ul><li>know the person first and foremost </li></ul><ul><li>reading, watching and thinking </li></ul><ul><li>( from ‘ Rainman ’ to ‘ Snowcake ’ and What’s eating Gilbert Grape, from Curious incident of the dog etc to ‘ Somebody Somewhere ’ and The Blue bottle Mystery ) </li></ul>
  9. 9. <ul><li>Training and learning processes </li></ul><ul><li>- collaboration and development </li></ul><ul><li>- Autism-friendly schools initiative, (Autism </li></ul><ul><li>Cymru, 2004 - and LEAs); identity card </li></ul><ul><li>initiative with the police service and others; </li></ul><ul><li>collaborative training processes in schools </li></ul><ul><li>(eg. Barrett, 2006) </li></ul>Barrett,M. (2006) ‘Like dynamite going off in my ears’. Using autobiographical accounts of autism with teaching professionals. Educational Psychology in Practice, 22 (2) 95-110
  10. 10. <ul><li>Differences can be noticed in the following : </li></ul><ul><li>Ways of being with other people (social relationships) </li></ul><ul><li>Ways of communicating and or speaking (social communication) </li></ul><ul><li>Fixed ways of thinking and doing things (social imagination) </li></ul><ul><li>These are known as the ‘triad of impairment’(Wing, 1996). </li></ul>
  11. 11. <ul><li>Solution- focused approaches (eg. Ajmal and Rees, 2001) </li></ul><ul><li>individual work </li></ul><ul><li>meetings </li></ul><ul><li>ways of hearing peoples’ stories and perspectives …. </li></ul><ul><li>‘ Our guard went up…’ never seen anything like it , ‘… told them the same thing a thousand times…’ ,’we are still waiting for the diagnosis…’ … these are severe impairments … ‘… differences not difficulties…’ </li></ul>
  12. 12. <ul><li>Solution- focused thinking </li></ul><ul><li>Helps people become aware of the effects of own actions, thoughts, behaviours on themselves and environment </li></ul><ul><li>Helps people consider own knowledge about the situation and consider own skills and opportunities to do something about it to resolve own difficulties. </li></ul><ul><li>Promotes self-reliance but needs to be facilitated. </li></ul><ul><li>Focus on the positive </li></ul><ul><li>What is going right ? </li></ul><ul><li>Look for exceptions ? </li></ul><ul><li>Scaling </li></ul><ul><li>Priorities for change not problems to be sorted </li></ul><ul><li>What would you see happening ? </li></ul><ul><li>Positive language leads to solutions </li></ul>
  13. 13. <ul><li>Scaling </li></ul><ul><li>Exceptions </li></ul><ul><li>Think about the times when what is troubling you wasn’t happening. What was happening then ? etc. </li></ul><ul><li>Miracle question </li></ul><ul><li>Imagine the issue has gone away. What is happening instead ? </li></ul>1 10 5 Last year/month today 1 5 10 6 months ?
  14. 14. <ul><li>Perspectives : autism and other learning and social profiles – the importance of a sense of perspective ? </li></ul><ul><li>Consultations, procedures and assessment frameworks - making guidance a reality … </li></ul><ul><li>Assessment: multi-agency (WAG Consultation paper 2006) </li></ul>
  15. 15. <ul><li>DfEE (Circular 10/99: Social Inclusion: Pupil Support) </li></ul><ul><li>lack of coordination of services to families from agencies and disciplines </li></ul><ul><li>Autism straddles different disciplines </li></ul><ul><li>- for definitions, diagnosis, education and care a multi disciplinary approach helpful. </li></ul>
  16. 16. <ul><li>Behavioural (biological) basis or </li></ul><ul><li>Not a pathological state ( part of normal biological variation, with advantages and disadvantages – problems arise from social attitudes not disabilities ) </li></ul><ul><li>Way forward consider: </li></ul><ul><li>- autism as a range of developmental characteristics in </li></ul><ul><li>social understanding, communication and flexibility of </li></ul><ul><li>thinking and behaviour </li></ul><ul><li>issues are around levels of adaptive functioning </li></ul><ul><li>- this respects individuals but recognises major difficulties in </li></ul><ul><li>coping with the world. </li></ul>
  17. 17. <ul><li>Autism affects: thinking, feeling and understanding but not same for everyone </li></ul><ul><li>understanding of the world comes from the social process of joint construction of meaning (Vygotsky, 1962) </li></ul><ul><li>How do we share the issues arising from this for people with autism with fellow professionals ? </li></ul>
  18. 18. <ul><li>No one approach will meet the needs of all people with autism (Jordan and Jones, 1999) </li></ul><ul><li>Key considerations; </li></ul><ul><li>how does the child/young person learn best ? </li></ul><ul><li>What barriers exist n? </li></ul><ul><li>What support would mean a child would not fail in a local setting ? </li></ul><ul><li>What setting is the least restrictive way of meeting needs and providing education ? </li></ul>
  19. 19. <ul><li>Multi-disciplinary input not just at crisis points </li></ul><ul><li>Time is a crucial resource </li></ul><ul><li>Autism outreach teams: multi-agency </li></ul><ul><li>See Cumine, Leach et al. (1997,2000); Leicester City Council, Leicestershire County Council and Fosse Health Trust, </li></ul><ul><li>(1998) </li></ul>
  20. 20. <ul><li>Easier said than done: multi-agency work is a complex psycho – social process – no wonder its tricky ! </li></ul><ul><li>Unique challenges for autism ? – impact of anxiety … </li></ul><ul><li>Differing professional positions and perspectives (social worker, clinical psychologist, nurse, paediatrician, psychiatrist, police, speech and language therapist, occupational therapist, teacher, teaching assistant, headteacher) </li></ul><ul><li>Unique perspective of the child/young person </li></ul><ul><li>Unique position of parents/carers </li></ul>
  21. 21. The National Autistic Society, City Rd, London, ECIU ING, tel 0171 833 2299. The NAS in Wales, William Knox House, suite C1, Britannic Way, Llandarcy, Neath, West Glamorgan, SA 10 6EL, Tel: 01792 8159 815915 Autism Cymru, 6, Great Darkgate, St, Aberystystwyth, SY23 1 DE Tel: o1970 625256 There are also many books on autism and the autistic spectrum. The following are among a growing number of accessible books. Hall. K.(1998) Asperger Syndrome, the Universe and Everything. London: Doubleday
  22. 22. The National Autistic Society , City Rd, London, ECIU ING, tel 0171 833 2299. The NAS in Wales , William Knox House, suite C1, Britannic Way, Llandarcy, Neath, West Glamorgan, SA 10 6EL, Tel: 01792 8159 815915 Autism Cymru , 6, Great Darkgate, St, Aberystystwyth, SY23 1 DE Tel: o1970 625256 Ajmal,Y and Rees, I (eds)(2001) Solutions in Schools. London:BT Press: Jordan, R.( 2001) Multidisciplinary work for children with autism, Educational and Child Psychology, 18(2) There are also many books on autism and the autistic spectrum. The following are among a growing number of accessible books. Hall. K.( 1998) Asperger Syndrome, the Universe and Everything. London: Doubleday
  23. 23. <ul><li>Williams, D. (1996) Autism: and inside out approach . London: Jessica Kingsley. </li></ul><ul><li>This is one of several books by a woman who readily </li></ul><ul><li>acknowledges and describes her own autism . </li></ul><ul><li>Haddon, M. (2003) The curious incident of the dog in the night time . London: Johnathon Cape. </li></ul><ul><li>An acclaimed novel written from the point of view of a young person with an autism spectrum condition. </li></ul><ul><li>Cummine, V., Leach, J. and Stephenson, G. (2000) Autism in the Early Years, A Practical Guide. London: David Fulton . </li></ul><ul><li>As above (1998) Asperger Syndrome, A Practical Guide for Teachers. London: David Fulton. </li></ul><ul><li>Jordan, R. and Jones, G. (1999) Meeting the Needs of Children with Autism Spectrum Disorders . London: David Fulton. </li></ul>