Saturday, October 29, 2011

Autism Teaching: America & France

When I began working in the autism field in the early 1970s, most thinking by professionals and non-professionals was greatly influenced by the psychoanalytic tradition of Bruno Bettleheim.  Well-established child psychiatrists showed more interest in the sex lives of the mothers of children with autism, than of ways to help them promote their children’s skills and more typical development.  I know of mothers who literally spent years trying to overcome the offensive comments of child psychiatrists who blamed them for their child’s autism.

My wife, Anneke Thompson (pictured above), is a retired special education teacher who started one of the first special education programs for children with autism in Minnesota. Before she started her program at the Hans Christian Anderson School in south Minneapols, we visited Rosalind Oppenheimer’s Rimland School near Chicago, Gerry Patterson in Eugene, and consulted with Ivar Lovaas.  Ivar referred her first student to her from St.Paul, MN during a visit many years ago.  She attempted to get the best evidence regarding which methods would most benefit her students, including Frank Hewitt’s Engineered Classroom.  My daughter is also a special education teacher who specializes in teaching children with severe behavioral challenges, including autism spectrum disorders.  This is by way of making it clear that I hold special educators in very high esteem. I laud their courage and thei often brilliant and creative ways they create terrific learning environments for their students.  But as with any other profession, incompetence among educators serving children with autism simply cannot be abided.

Many of us were using behavioral intervention methods, working one-to-one with children with autism in families’ homes and in schools before Lovaas’s landmark study, mainly because there were no resources in school programs.  But none of us used comprehensive and intensive interventions as had Lovaas.  There were essentially no meaningful services for the vast majority of children with autism until the emergence of Early Intensive Behavioral Intervention following Lovaas’s milestone 1987 article, demonstrating that half of the children receiving 3-4 years of treatment were able to function in regular education settings with minimal supplementary supports, and most of the rest improved as well, but less dramatically. 

Fortunately, the influence of psychoanalytic thinking has largely disappeared from autism treatment in the US, which is a great source of relief, though it lingers in attachment theory approaches.  There is currently a battle waging in France over the domination of of autism services by psychoanalytically-trained psychiatrists who are continuing to spew totally mistaken, unwarranted, undemonstrated and damaging views of alleged maternal causes of autism, which are sheer fantasy.  They are making up stories like shepherds of ancient times who looked up into the sky at night and created captivating tales about the constellations and their symbolic meaning.  You can see examples in the excellent documentary, Le Mur, by Sophie Roberts, which the French psychoanalysts are trying to suppress through litigation.

While we have reason to be pleased that such unprofessional nonsense is mostly behind us in the United States, we continue to have serious problems in our public education systems throughout the country.  While there are some forward-looking school districts, that have embraced the best evidence-based practices that are to be applauded, far too many cling to disproven methods which deprive young children with autism of effective educational services.  

Though there is no objective evidence autism is an attachment disorder as described by Bowlby’s and Ainsworth’s attachment models, or current DSMIV-TR definitions, some school programs employ Floortime® intervention which is based on attachment theory, for which there is virtually no evidence that it is beneficial to children with autism.  Others castigate community providers for employing applied behavior analytic methods for working with young children with autism, warning parents that they will turn the children into “robots” or that it amounts to “dog traning,” while simultaneously adopting ineffective methods based on mistaken extrapolations of Piaget’s and Vygotsky’s developmental models, which were based on studying small samples of very bright typically developing children.  Most of them who make such remarks have never seen EIBI intervention taking place in the real world, or examples of child outcomes such as the child and therapist shown here, robot indeed.  About 60% of the children who received such blended behavior analytic interventions are now in regular education, most without supplementary supports. 

Public schools in the US generally adopt the stance that they are professionals and know what they are doing, and reject the notion they need any guidance from parents or outside professionals about how to do their jobs. They usually hide behind rules or policies that state that outsiders can’t work in schools assisting their students’ learning.  Public schools often do an excellent job in teaching the three-R’s to average and high achieving students.  But regrettably, too few seem to know very much at all about which teaching methods are most effective for young students with autism.  If they are aware of them, they reject them out of hand, almost as a matter of religious conviction.

No doubt many small town general practitioners felt the same way when modern advances in medical practice arrived, introducing ways of preventing infections and treating communicable diseases and reducing deaths due to "childbirth fever."  Those docs thought they knew how to deal with such problems and resented meddling outsiders. But medicine changed and adopted modern methods.  

 It is unconscionable that American public school personnel in the 21st century have the option of rejecting evidence-based interventions out of hand, in favor of demonstrably ineffective methods, simply because they say they prefer them.  That would be like a doctor deciding to use poultices or purging to treat epilepsy or hypertension because he or she preferred them.

 Because school personnel nearly entirely determine what goes on in public schools, educational practices in the US for children with autism mirror what is going on with psychoanalysts in France.   Uninformed people who seem to have no obligation to be aware of objective evidence of what works best for the benefit of children with autism, in both cases, are determining the future American and French children with autism spectrum disorders.  The fact that far too many parents of children with autism have been shut out of their children’s education by defensive school personnel who reject any suggestion that more effective teaching methods be employed or any assistance whatsoever from the highly trained staff in many cities throughout the US who are generally ready and willing to assist them, the youngsters, far too often, are inappropriately and incompetently served.

There are colleges of education in the United States that do not even teach applied behavior analytic strategies for teaching children with autism.  That would be like medical schools not teaching would-be doctors how to effectively treat and manage diabetes.  No college of education that offers autism specialty training should be accredited that does not teach their special education teachers in training how to use state of the art teaching methods for students with autism.

I am a professor who teaches in a college of education.  I teach courses in autism for special education teachers.  I want to be very clear, I do not disrespect or disapprove of teachers or educators.  I greatly empathize with their very difficult jobs and admire those true heroes who do remarkable work day in and day out and receive very little to no credit. Autism teachers are hit, bit and sometimes spit at. I get it.  It’s very hard work.   For years I watched my wife working on lesson plans for the next day for her students with autism until late into the night, and purchasing her own teaching supplies.   

But I continue to be shocked and appalled that school systems permit the use of incompetent practices that seriously impede the future development of our children with autism.  That has to change in both the US and France.   

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