Last Thursday, on February 18, I made a visit to a workshop held by Tech Kids Unlimited, where I worked one on one with a few kids on the spectrum and observed the social dynamics of the overall group. I helped the oldest student Oscar enter a story he was writing (about a nuclear radiation-created monster loose in London) in Microsoft word into a template on storybook.com. He was very resistant to using template or images to present his story. He preferred to just keep writing in Microsoft word. After a bit of convincing and demonstration of how the story would look if we copied and pasted one paragraph to each page, Oscar consented with a reluctant "fine." I had won the first battle with Oscar, but I had not scored any points in his book. I had a similar experience with Mathias, the next oldest student, but I was unable to reach him at all. I didn't even get a cold, hard "fine."
I understood going into this experience that it would not be like working with my neuro-typical tutoring students. I was not offended, or even agitated, by the interactions, but I could see how the struggle to connect emotionally with one's own child would be painful and draining. I could see why a parent might try to "cure" his or her child's autism.
On Thursday, February 22, I met with Kristie Koenig, an occupational therapist at Steinhardt who specializes in ASD and SPD. She described a strength based approach to care, which recognizes and works on weaknesses, but finds ways for individuals on the spectrum to minimize anxiety and excel in areas of strength. She clarified the different types of sensory processing disorders: sensory modulation, sensory discrimination, and motor planning and learning. She explained the difference between hypo and hyper responsive sensory modulation disorders, as well as sensory seeking habits, which I had been previously confused about.
I mentioned the idea of a movement simulation device. She showed me a video of Paul Kotler, a non-verbal adult on the spectrum, on ice skates, where he is able to experience fluid movement in a way that he cannot on his own two feet. She thought that providing access to pleasurable movement experienced to people with motor planning and execution disabilities could be beautiful and empathetic. She also directed me to his blog, which she thinks will help me understand Paul's experience of reality a bit better.
To wrap up our meeting, Kristie sent me a few introductory lectures on sensory processing disorders and ASD from an occupational therapy perspective, in addition to a study of the efficacy of regular yoga in ASD educational programs. She also suggested a few neuroscientists who work on ASD and sensory processing, but neither are at NYU. All of these are helpful leads.
Occupational Therapy
Occupational therapists work with children, families, and school systems to diagnose, treat, and accommodate sensory processing and Autism Spectrum disorders. They work with individuals and their communities to identify strengths and weaknesses and develop systems of support so that individuals on the spectrum can excel in areas of high ability with minimal interference from characteristic challenges. The field of occupational therapy developed in response to inhumane treatment of the mentally ill and exemplifies a strength-based approach to treatment, designed to maximize quality of life for persons living with Autism rather than contain eccentricities or cure the ailment of the neurological makeup.
Because each person on the spectrum is affected differently, occupational therapists design individualized plans, addressing specific sensory needs of each person, and educating care-givers and families on how to accommodate these needs, minimizing anxiety attacks and maximizing potential for enjoyment, engagement, and learning in areas of special interests. Occupational therapists also design and evaluate programs for people on the spectrum in school settings. They help schools and educators create positive learning environments for people on the spectrum and identify practices that can contribute to the overall educational experience.
Dance Science
Dance science provides a framework for analyzing expressive qualities in human movement, as well as the sensory perception that goes into motor planning and decision-making. Dance scientists have studied classification of human movement quality for decades, often using Laban Movement Analysis as a system for understanding quality of movement according to time, space, weight and flow. LMA qualities can be extended and contextualized to understand emotional content of a particular movement. Dance scientists also study improvisation and the development of tools for responding to unpredictable sensory input. I wonder if improvisational exercises would benefit a person on the spectrum, providing them with tools for handling physical and social interactions with other people more comfortably and confidently. I wonder if the practice of responding organically (or feigning organic responses) could help to stimulate nerve growth that would enable individuals to better handle unexpected situations in normal daily life. Or if practicing physical expression through dance concepts could develop the pathways in a person's brain that regulate this kind of activity non-consciously.
Education: Standard and Special Needs
Educational practices for students with special needs have evolved over time, especially in the last century. Informed by the work of developmental psychologists, neural scientists, and occupational therapists, as well as public policy on education and disabilities, special needs education programs are designed to be supportive of individuals who learn differently, including those on the Autism Spectrum. Students on the spectrum may go through these programs and develop a sense of identity within greater social contexts, as well as habits for interacting with others. Educational specialists are tasked with creating the most supporting programs possible to develop functional habits that will lead to successful adult lives and careers.
Students who are high-functioning may go through standard, neuro-typical educational programs, developing a sense of their strengths and weaknesses according to a system that is not designed with their needs in mind. The field of education is responsible for conditioning individuals on the spectrum, as well as not on the spectrum, to interact with the people around them in the context of accomplishing tasks. This conditioning is heavily influential in the success and happiness of individuals in the long term.
Policy: Disabilities and Education
Public policy regarding education, disabilities, and diversity is important in shaping the lives of people on the spectrum. Guided by empirical studies and scientific understanding of human needs and behavior, law-makers create and regulate the systems by which people on the spectrum are educated and accommodated, as well as the systems by which neuro-typical people are educated on diversity and disabilities. Policy creates support and research organizations, mandates accommodations and fair treatment, and allocates resources to aid affected individuals and organizations that help them.
For example, the Centers for Disease Control and Prevention (CDC) is the leading national public health institute of the United States. The CDC is a federal agency under the Department of Health and Human Services. Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability.
The American Psychiatric Association is an organization of psychiatrists working together to ensure humane care and effective treatment for all persons with mental illness, including substance use disorders. It is the voice and conscience of modern psychiatry. Its vision is a society that has available, accessible quality psychiatric diagnosis and treatment. The APA publishes the DSM5 Diagnostic and Statistical Manual of Mental Disorders, which is the standard classification of mental disorders used by mental health professionals in the United States and contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. DSM is used in both clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care) as well as with community populations. In addition to supplying detailed descriptions of diagnostic criteria, DSM is also a necessary tool for collecting and communicating accurate public health statistics about the diagnosis of psychiatric disorders.
Another relevant organization is Employment Alliance for People with Disabilities, which runs the Ticket to Work program to guide individuals with disabilities through the process of finding appropriate work and accommodations. Relevant legislation includes the Individuals With Disabilities Education Improvement Act of 2004, which determines the support and accommodations provided to individuals of different disabilities in the public education setting.
Management and HR
Management and human resources personel are responsible for hiring and directing employees for a company. If not educated on the needs and strengths of people with AS and ASD, employers are far less likely to give someone on the spectrum the opportunity to work. Similarly, they are far less likely to provide the appropriate tasks, feedback, and environment necessary to the success of a person on the spectrum. As disability and diversity policy change, management and human resources are learning about employing people with ASD and AS. Hopefully, the field of management will catch up, and employers will learn in school about utilizing the strengths of people on the spectrum and minimizing their challenges in the workplace.
Child Psychology and Cognitive Development
Our understanding of sensory processing in neuro-typical people and people on the spectrum is guided by our understanding of how infants learn to interpret the world around them. By conceptualizing how motor planning and sensory processing work, as well as non-verbal communication in infants, we can design assistive technologies, occupational therapies, and intervention programs to maximize success and empathy for people on the spectrum.
Neural Science of genders, Autism, and sensory processing
Again, as we learn how different brains process and interact with their environments, we can provide insight into communicating better with people of various neurological characteristics. It has been suggested that differences between male and female brains could be responsible for fewer ASD and AS diagnoses in females. The female brain characteristically has more connections between distal points, which results in generally more empathetic behavior. The result is that women can better imitate behaviors of their peers to cover up the symptomatic expression of ASD and AS. This results in a lot of misdiagnoses in females like general anxiety disorder, depression, and obsessive compulsive disorder, which miss the underlying cause of structural differences in the brain, and also prevent females from learning their unique needs and strengths and how to maximize their happiness accordingly.
As we learn more about sensory processing and motor planning, it may be possible to design earlier intervention therapies to strengthen developmental weaknesses of people with ASD and AS. Neural science theory can guide occupational therapy towards the most effective practices.
