Autism. New Directions in Research and Education PDF
Preview Autism. New Directions in Research and Education
Related Titles Cartledge/Milburn Teaching Social Skills to Children Goldstein Prescriptions for Child Mental Health and Education Schwartz/Johnson Psychopathology of Childhood: A Clinical- Experimental Perspective Wing Early Childhood Autism: Clinical, Educational, and Social Aspects, 2nd Edition iûpTSM New Directions in Research and Education Edited by Christopher D. Webster Metropolitan Toronto Forensic Service M. Mary Konstantareas Clark Institute of Psychiatry. Toronto Joel Oxman York University. Ontario Judith E. Mack York University. Ontario Pergamon Press New York · Oxford · Toronto · Sydney · Frankfurt · Paris Pergamon Press Offices: U.S.A Pergamon Press Inc., Maxwell House, Falrview Park, Elmsford, New York 10523, U.S.A. U.K. Pergamon Press Ltd., Headington Hill Hall, Oxford 0X3 OBW, England CANADA Pergamon of Canada Ltd., 150 Consumers Road, Willowdale, Ontario M2J 1P9, Canada AUSTRALIA Pergamon Press (Aust) Pty. Ltd., P.O. Box 544, Potts Point, NSW 2011, Australia FRANCE Pergamon Press SARL, 24 rue des Ecoles, 75240 Paris, Cedex 05, France FEDERAL REPUBLIC Pergamon Press GmbH, 6242 Kronberg/Taunus, OF GERMANY Pferdstrasse 1, Federal Republic of Germany Copyright © 1980 Pergamon Press Inc. Library of Congress Cataloging in Publication Data Main entry under title: Autism, new directions in research and education. (Pergamon policy studies) Bibliography: p. Includes index. 1. Autism. I. Webster. Christopher D., 1936- RJ506.A9A923 1980 618.9'28'982 79-19732 ISBN 0-08-025083-1 All Rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic tape, mechanical, photocopying, recording or otherwise, without permission in writing from the publishers. Printed in the United States of America To George y Lorne Timmy Joey Marlene y Ppinder and the y y t many other children and their families Foreword Childhood autism and related conditions can be defined by the presence of severe language impairments, poverty of social interaction, and repetitive stereotyped activities in place of the imaginative and social pursuits of normal children. Behind the apparent simplicity of this description lies a bewildering complexity. The defining characteristics vary in their severity and the precise form they take. Although some organic conditions are reported more often than others, autism can be associated with virtually any kind of pathology affecting the central nervous system. The details of the clinical picture differ between children, and they also change with the environment and with age. If these facts are not enough to daunt those working in this field, it is becoming increasingly clear that many different patterns of language, cognitive, and perceptual impairments can be found in children with the autistic behavior pattern. The special interest and pleasure of this book lies in the fact that the editors and their co-authors acknowledge the diversity of the phenomena classified under the label of autism, and accept that no universal solution to the problems of aeti ology, education, and management can be found. The chapters describing the experiences of the families, and the engaging account of the trials and tribulations of a psychologist working with an autistic child are used to underline the necessity for professionals to learn something new from every child with whom they work. The discussions of the successes and failures of educational programs continue this theme and lead on to a detailed and helpful section on the value and limitations of a method of teaching language through simultaneous use of signs and speech. An important point emphasized throughout the work, and one with which I am in whole-hearted agreement, is that an autistic child can be helped only if a serious attempt is made to see the world from his point of view, so that the adaptive function of much of his peculiar behavior can be understood in the context of his handicaps. This contrasts with the rigid behaviorist approach of "if it is socially unacceptable, eliminate it," but does not preclude the use of behav ioral methods that have proven useful in practice, as one part of a wide edu cational approach. Being closely involved in both aspects of the problems of autism, I particularly appreciate the collaboration in this book of parents and professional authors. Readers, whatever their connection with the subject, will find this book thought-provoking, stimulating, and a source of new ideas, both theoretical and practical. Lorna Wing xi Preface In the early 1970s, a few of us within the Child and Family Studies Centre of the Clarke Institute of Psychiatry in Toronto began to work with autistic children and their families. Our approach initially involved language and socialization training with a few children and home management programming with their families. With the formation of a clinical research team, we began a simultaneous com munication program for a number of nonverbal autistic children. The progress of the children in that program was quite encouraging, and our efforts to pursue work in the field became intensified. We began to think that we were finding some answers to the many puzzling questions about the severe communication deficits and social isolation of autistic children, and we were soon involved in a good deal of clinical and research work, teaching and consultation. The hypoth eses and ' 'answers" which we were beginning to formulate, however, were increasingly challenged by both old and new questions concerning the etiology of autism, the actual clinical and developmental progress of the children, and our sometimes unsatisfactory attempts to design optimally effective educational and therapeutic procedures for them. As we came to know each individual child better, we realized that our original operant-based treatment approach had to be tempered with a greater appreciation of the complexity of the autistic syndrome itself. We then embarked on a series of clinical research projects, laboratory, observational, and theoretical studies. We became concerned, for instance, with normal and atypical patterns in the development of social play, speech and language acquisition, the communicative and cognitive functions of speech, gesture and sign language, ethological theory, microkinesic research, the impact of parental and family involvement on the child's treatment, and with some of the children's unique ways of gathering information from their environment. We began to realize the necessity of study ing each child's ability to make use of perceptual, proprioceptive, and sensory cues in learning and problem solving. Through these endeavors, and our involvement with the children and their families, we came to adopt a certain viewpoint about autism and related dis orders—a perspective which has guided, and continues to direct, our clinical work and our understanding of this puzzling phenomenon. In this volume, we have assembled a series of formal and informal papers in an attempt to describe this perspective. The various chapters are intended to provide some detail of our clinical and research effort, and to reflect our particular view on autism. In offering this collection of articles, we hope to provide information, thoughts, and xiii xiv Preface questions which might prove useful to other researchers, clinicians, teachers, and students. Our primary objective, of course, is that by elaborating this perspective on autism, others might employ and expand it in their work; and we especially hope this study may induce other people at least to study, if not to change, their own manner of relating to autistic persons. While the position we offer can be best appreciated by reading at least some of the chapters contained in this book, it is perhaps necessary to give the reader a general idea of what this involves, and of what lies ahead. We have come to take a position which incorporates some aspects of the medical-psychological tradi tion and some aspects of the descriptive-subjective point of view. The former position (exemplified by the recent writings of Colman, 1976; and Ritvo, Freeman, Ornitz, and Tanguay, 1976) may be characterized by a commitment to carefully controlled laboratory studies, the explicit definition of behavioral characteristics, and stimulus-response contingencies, and by the study of observ able and 4tre.liable" indexes of development and functioning. Much of the re search carried out in this tradition has been concerned with aspects of information-processing, metabolic errors, genetic abnormalities, and neurolog ical impairments. That this approach to the study and treatment of autistic people is of importance can hardly be doubted, and we have followed it in much of our work. The descriptive-subjective point of view (characterized by such works as Kaufman's Son Rise, 1976), however, has also been an integral part of our work and study. Articles and books in this tradition are often the contributions of articulate parents, siblings, and teachers of autistic children. Those writing from this perspective are concerned with providing detailed, personal accounts of their children, and of their successes and failures in trying to help the children cope with the demands of an often difficult world. Importantly, it would seem that our clinical and research endeavors should be aligned with the expressed priorities and values which so many parents hold for their children. Our structured inter views with parents, some of which are outlined in the text, remind us that we must have an eye to ensuring that the child derives enjoyment and satisfaction from life. As we attempt to show, important and challenging positions, some times similar to those found in the medical-psychological tradition, have recently come from this orientation. The overall view of autism which we have adopted, then, is one which com bines various contributions from both of these major traditions. Our own and others' research over the past decade has made it quite clear that autistic children are beset by extensive and severe learning disabilities. We propose that the children's extreme difficulties with the perception, processing, and retention of sensory information begin in infancy. Such deficits would seem to be integrally related to problems of cognitive and affective development and functioning. It appears quite probable, as well, that the academic, communicative, and social problems of many autistic children may be the result of neurological, biochem ical, and/or genetic abnormalities. Our approach to working and interacting with the children aims at taking these factors into account. Providing the children with Preface xv an appropriate and usable perceptual environment is a central aspect of our approach, as is helping the children to discover and employ their strongest information-processing and communicative modalities. The reader will note that we have placed very heavy emphasis on simultaneous communication (sign language together with spoken words) as an avenue through which relationships can be formed. There are several reasons for doing this: first, no other book on autism has stressed this approach; second, the ideas underlying the use of the technique seem fundamentally useful in teaching; third, our experience with these methods has been rewarding for us and, we believe, for the children. While we do not subscribe to the view that autism results from inadequate mothering in early childhood, our own and others' studies of interactional or ganization have strongly suggested that the cognitive and perceptual deficits associated with autism can result in severe disruption and retardation of social and emotional development. In^particular, we have come to appreciate the very central role of communication deficiency in the development of the autistic syndrome, and stress the need to employ educational and therapeutic procedures which might, at least partially, alleviate the child's aloneness. The perspective we present, then, is one characterized by an overriding con cern for meeting the autistic child in mutual territory. We expect of the children that they attempt to learn and approach our conventional manners of com municating and interacting. At the same time, however, we demand of ourselves that we try to approach the children in their world. Quite obviously, such en deavors require careful consideration of experimental findings on the modality preferences and conceptual capacities of the children, as well as a thoughtful consideration of their motivations and hesitancies to interact with others. Our point of view is one which advocates the inclusion of our intuitions about the children along with our laboratory findings in an attempt at building a model of autism which might make our understanding of this puzzling phenomenon a little clearer. This means that we must try to be both ' 'objective' ' and ' 'subjective' ' about the children and about the study of autism. It is just such a rapprochement between the two traditions discussed, we believe, which is called for in the study of this disorder and in a sensitive approach to treatment and communication with the children. Our hope is that the present effort to write a book combining these two points of view may help to bring together parents and clinicians for the benefit of autistic children. In addition to the parents and clinicians, the book is addressed to the eager college or university student who is searching to under stand the many facets of the world of the autistic child. Over the years we have worked with many bright and stimulating students and have come to appreciate that it is their hard work and dedication that may help us overcome the many constraints that still prevent us from understanding fully this unique disorder. Acknowledgments We would like to thank all of those parents who allowed us to contribute their material to this book. Also we acknowledge with thanks the publishers of the Journal of Autism and Childhood Schizophrenia for allowing us to report the 1973 article by Webster et al., the 1977 comment on punishment, and two figures from the Sherman and Webster (1974) paper. Academic Press is to be thanked for allowing us to reproduce figures from an article by Konstantareas et al. (1978); and the Journal of Child Psychology and Psychiatry for allowing us to reproduce three tables and a figure from another article by Konstantareas et al. (1979). We thank the Journal of Applied Behavior Analysis for permission to publish parts of an article by Wintre and Webster (1974) and also for permitting us to quote from a paper by Lovaas et al. (1973) as well as including one figure from that paper. We thank Child Care Quarterly for allowing us to reproduce a version of the Webster et al. (1978) article. We also wish to thank Sign Language Studies for permission to reproduce Oxman et al. (1978) in its entirety. The reader will note that we have made extensive use of Helen Keller's The Story of My Life, first published by Grosset and Dunlap, 1904. Dr. Harvey Golombek, as Chief of the Child and Family Studies Centre at the Clarke Institute of Psychiatry, gave our work much needed support as did his successor, Dr. Gordon Warme. We would also like to extend our appreciation to Dr. Frederick Lowy, Director of the Institute, for providing an atmosphere conducive to research. We also thank students in a three week 1976 summer credit course on autism at the University of British Columbia for their comments on an early draft of this book. Ms. Erison Taylor took those comments into account as she completed an overall revision of the draft. There can be no doubt that without her good sense, hard effort and editorial skill this book would not have come into being. The project as a whole would never have been completed had we not received financial support from the Ruth Schwartz Foundation, The Clarke Institute of Psychiatry Research Fund, Health and Welfare Canada to CD. Webster (Grant No. 606-1050-29) and to M.M. Konstantareas (Grant No. 606-1240-44), The Ontario Mental Health Foundation (Grant No. 469), The University of Victoria Faculty Research Fund, and the British Columbia Medical Research Foundation. The publication of this book was assisted by a grant kindly made to the authors by the Hospital for Sick Children Foundation. To our typist, Linda Prichard, many thanks. Thanks are due to Mrs. Margaret McKay for helping with many of the final details of the manuscript. Our appreci- xvii x viii Acknowledgments ation is also extended to the editorial staff of Pergamon Press. But our warmest praise needs to be saved for all the children and parents who participated so willingly and cheerfully in all our testing sessions, interviews, and experiments.
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